Provider Demographics
NPI:1861805202
Name:LAM, JASON TRINH (DDS)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:TRINH
Last Name:LAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3909 BRYCE RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22312-1022
Mailing Address - Country:US
Mailing Address - Phone:703-354-0581
Mailing Address - Fax:
Practice Address - Street 1:3909 BRYCE RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22312-1022
Practice Address - Country:US
Practice Address - Phone:703-354-0581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414468122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist