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General NPI Number Information
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NPI Number | 1164979589
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Entity Type | Organization
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Legal Business Name | DIN LAM DMD, MD, PLLC
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Dates
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Enumeration Date | 09/01/2016
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Last Update Date | 09/01/2016
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Provider Practice Location Address
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Address Line | 605 INDIAN TRAIL RD S
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-7682
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Country | US
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Telephone | 646-584-8007
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Fax |
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Provider Business Mailing Address
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Address Line | 605 INDIAN TRAIL RD S
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City | INDIAN TRAIL
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State | NC
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Zip | 28079-7682
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Country | US
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Telephone | 646-584-8007
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. DIN LAM
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Credential | DMD, MD
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Telephone | 646-584-8007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 9847
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License Number State | NC
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