Individual
JESSICA LAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
198 CANAL ST STE 402, NEW YORK, NY 10013-4533
(212) 766-2128
Mailing address
198 CANAL ST STE 402, NEW YORK, NY 10013-4533
(212) 766-2128
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
062258
NY
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/11/2020
Last updated
01/28/2022
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