1720043169 NPI number — DR. MAGGIE TRANG LAM DDS

Table of content: DR. MAGGIE TRANG LAM DDS (NPI 1720043169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720043169 NPI number — DR. MAGGIE TRANG LAM DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LAM
Provider First Name:
MAGGIE
Provider Middle Name:
TRANG
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720043169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1761 E WARNER RD
Provider Second Line Business Mailing Address:
STE #A-14
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85284-4558
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-755-3320
Provider Business Mailing Address Fax Number:
480-755-3380

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1761 E WARNER RD
Provider Second Line Business Practice Location Address:
STE #A-14
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85284-4558
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-755-3320
Provider Business Practice Location Address Fax Number:
480-755-3380
Provider Enumeration Date:
04/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  6178 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1767876 . This is a "UNITED CONCORDIA" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 892902 . This is a "AHCCCS" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".