Provider Demographics
NPI:1518225853
Name:LAM, GRACE LEE (DDS)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:LEE
Last Name:LAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6325 SAUNDERS ST
Mailing Address - Street 2:7G
Mailing Address - City:REGO PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11374-2034
Mailing Address - Country:US
Mailing Address - Phone:646-705-4749
Mailing Address - Fax:
Practice Address - Street 1:8028 COOPER AVE
Practice Address - Street 2:#207
Practice Address - City:GLENDALE
Practice Address - State:NY
Practice Address - Zip Code:11385-7711
Practice Address - Country:US
Practice Address - Phone:718-894-2110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-04-24
Last Update Date:2014-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0574021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry