Provider Demographics
NPI:1699725705
Name:LAM, SHEILA MARIE (DDS)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:MARIE
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SHEILA
Other - Middle Name:M
Other - Last Name:MCLOUGHLIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:485 WILDWOOD PARKWAY
Mailing Address - Street 2:STE 3
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63011
Mailing Address - Country:US
Mailing Address - Phone:636-227-7055
Mailing Address - Fax:636-527-3900
Practice Address - Street 1:485 WILDWOOD PARKWAY
Practice Address - Street 2:STE 3
Practice Address - City:BALLWIN
Practice Address - State:MO
Practice Address - Zip Code:63011
Practice Address - Country:US
Practice Address - Phone:636-227-7055
Practice Address - Fax:636-527-3900
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO015354122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist