Provider Demographics
NPI:1447447842
Name:PETER H LAM DDS INC
Entity type:Organization
Organization Name:PETER H LAM DDS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:HONGTAI
Authorized Official - Last Name:LAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MS
Authorized Official - Phone:650-638-1500
Mailing Address - Street 1:3455 PACIFIC BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2836
Mailing Address - Country:US
Mailing Address - Phone:650-638-1500
Mailing Address - Fax:650-638-1511
Practice Address - Street 1:3455 PACIFIC BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2836
Practice Address - Country:US
Practice Address - Phone:650-638-1500
Practice Address - Fax:650-638-1511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-28
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA429271223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty