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General NPI Number Information
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NPI Number | 1497009831
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Entity Type | Organization
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Legal Business Name | KEITH H TAM DDS INC
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Dates
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Enumeration Date | 11/07/2012
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Last Update Date | 01/27/2022
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Provider Practice Location Address
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Address Line | 2674 SAN MIGUEL DR
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5437
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Country | US
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Telephone | 949-478-6628
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Fax |
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Provider Business Mailing Address
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Address Line | 2674 SAN MIGUEL DR STE C
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-5437
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Country | US
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Telephone | 949-478-6628
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Fax |
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Authorized Official
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Title or Position | OWNER, DDS
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Name | DR. KEITH H TAM
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Credential | DDS
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Telephone | 949-322-9778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 57293
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License Number State | CA
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