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General NPI Number Information
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NPI Number | 1164635439
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Entity Type | Organization
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Legal Business Name | SENECA PARK DENTISTRY
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 13529 CLOPPER RD
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City | GERMANTOWN
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State | MD
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Zip | 20874-2132
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Country | US
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Telephone | 301-515-9677
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Fax | 301-515-9614
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Provider Business Mailing Address
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Address Line | 13529 CLOPPER RD
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City | GERMANTOWN
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State | MD
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Zip | 20874-2132
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Country | US
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Telephone | 301-515-9677
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Fax | 301-515-9614
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Authorized Official
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Title or Position | PROPRIETOR
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Name | DR. TONY T LAM
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Credential | D.D.S.
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Telephone | 301-515-9677
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 0401008267
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 11937
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License Number State | MD
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