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General NPI Number Information
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NPI Number | 1518225853
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Entity Type | Individual
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Provider Name | GRACE LEE LAM DDS
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Gender | Female
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 11/18/2014
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Provider Practice Location Address
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Address Line | 8028 COOPER AVE #207
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City | GLENDALE
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State | NY
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Zip | 11385-7711
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Country | US
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Telephone | 718-894-2110
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Fax |
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Provider Business Mailing Address
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Address Line | 6325 SAUNDERS ST 7G
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City | REGO PARK
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State | NY
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Zip | 11374-2034
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Country | US
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Telephone | 646-705-4749
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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 | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 057402
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License Number State | NY
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