Provider Demographics
NPI:1083879258
Name:LAM, NICOLE PHUONG (DMD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:PHUONG
Last Name:LAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7277 SASHAYING SPIRIT CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-2356
Mailing Address - Country:US
Mailing Address - Phone:702-328-8349
Mailing Address - Fax:
Practice Address - Street 1:4343 N RANCHO DR STE 131
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89130-3422
Practice Address - Country:US
Practice Address - Phone:702-395-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-27
Last Update Date:2008-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV57301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice