MEDICARE: DR. LISA LAM D.D.S.

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	57669	CA

General Provider Information

NPI Number	:	1356592398
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISA LAM D.D.S.

Provider Business Mailing Address
First Line	:	7325 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-0420
Country	:	US
Telephone Number	:	707-979-3068
Fax Number	:	79-797-2627

Provider Business Practice Location Address
First Line	:	7325 S RAINBOW BLVD STE 100
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89139-0420
Country	:	US
Telephone Number	:	707-979-3068
Fax Number	:	707-979-7262

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

Provider Enumeration Date	:	10/08/2008
Last Update Date	:	01/31/2024

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