MEDICARE: DR. ANTHONY THANH 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	1223G0001X	General Practice Dentistry	DS035152	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1093703233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANTHONY THANH LAM D.M.D.

Provider Business Mailing Address
First Line	:	1611 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1003
Country	:	US
Telephone Number	:	215-271-6999
Fax Number	:

Provider Business Practice Location Address
First Line	:	1611 S BROAD ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19148-1003
Country	:	US
Telephone Number	:	215-271-6999
Fax Number	:

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

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/11/2008

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