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General NPI Number Information
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NPI Number | 1487717187
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Entity Type | Individual
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Provider Name | KENNY DAO LAM D.D.S
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Gender | Male
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 10/22/2008
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Provider Practice Location Address
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Address Line | 4410 S RIO DR
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City | CHANDLER
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State | AZ
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Zip | 85249-3382
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Country | US
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Telephone | 480-786-0557
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Fax |
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Provider Business Mailing Address
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Address Line | 4410 S RIO DR
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City | CHANDLER
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State | AZ
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Zip | 85249-3382
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Country | US
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Telephone | 480-786-0557
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 051761
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | D7529
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License Number State | AZ
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