Provider Demographics
NPI:1871720029
Name:LAM, NANCY NHU QUYNH (DDS)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:NHU QUYNH
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NHU
Other - Middle Name:QUYNH NGOC
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1652 116TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:BLAINE
Mailing Address - State:MN
Mailing Address - Zip Code:55449-4661
Mailing Address - Country:US
Mailing Address - Phone:763-742-2774
Mailing Address - Fax:
Practice Address - Street 1:636 BROADWAY ST NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-2164
Practice Address - Country:US
Practice Address - Phone:612-746-1530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12684122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist