Provider Demographics
NPI:1427256338
Name:TAM, LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:TAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 JOHN STREET STE 530
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-2766
Mailing Address - Country:US
Mailing Address - Phone:212-619-7899
Mailing Address - Fax:
Practice Address - Street 1:111 JOHN ST RM 530
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-0077
Practice Address - Country:US
Practice Address - Phone:212-619-7899
Practice Address - Fax:212-619-0735
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-03
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY052091122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist