Provider Demographics
NPI:1730495540
Name:CAM, LYDIA B (DDS)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:B
Last Name:CAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1108 CORPORATE WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-6118
Mailing Address - Country:US
Mailing Address - Phone:916-395-5700
Mailing Address - Fax:
Practice Address - Street 1:1108 CORPORATE WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-6118
Practice Address - Country:US
Practice Address - Phone:916-395-5700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2014-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59490122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist