MEDICARE: LISA N. LAM, PLLC

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1912775487
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISA N. LAM, PLLC

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	:

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	:	831-262-8845
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LISA LAM
Credential	:
Telephone Number	:	707-979-3068

Provider Enumeration Date	:	12/14/2023
Last Update Date	:	12/14/2023

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