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General NPI Number Information
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NPI Number | 1760694871
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Entity Type | Individual
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Provider Name | THAI TOM LAM DDS
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Gender | Male
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 03/26/2010
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Provider Practice Location Address
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Address Line | 10165 FOOTHILL BLVD SUITE # 4, 5
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0340
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Country | US
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Telephone | 818-458-2516
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Fax |
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Provider Business Mailing Address
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Address Line | 10165 FOOTHILL BLVD SUITE # 4, 5
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0340
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Country | US
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Telephone | 818-458-2516
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 54770
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 54770
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License Number State | CA
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