MEDICARE: DR. COLLEEN LAM D.M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN19427	FL

General Provider Information

NPI Number	:	1013200187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. COLLEEN LAM D.M.D.

Provider Business Mailing Address
First Line	:	5057 S CONGRESS AVE STE 401
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4723
Country	:	US
Telephone Number	:	561-965-6003
Fax Number	:	561-965-8447

Provider Business Practice Location Address
First Line	:	5057 S CONGRESS AVE STE 401
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33461-4723
Country	:	US
Telephone Number	:	561-965-6003
Fax Number	:	561-965-8447

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2011
Last Update Date	:	10/25/2017

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