Provider Demographics
NPI:1366918476
Name:LAM S. CHU, D.D.S., P.A.
Entity type:Organization
Organization Name:LAM S. CHU, D.D.S., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:LAM
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:CHU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:336-835-7500
Mailing Address - Street 1:129 N BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-2219
Mailing Address - Country:US
Mailing Address - Phone:336-835-7500
Mailing Address - Fax:336-835-6809
Practice Address - Street 1:129 N BRIDGE ST
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-2219
Practice Address - Country:US
Practice Address - Phone:336-835-7500
Practice Address - Fax:336-835-6809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-16
Last Update Date:2018-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899007JMedicaid