Pedro Lam
Individual provider Active NPI General Practice Dentistry · Great Falls, VA
NPI 1992295992 · NPPES record last updated May 17, 2023
Key facts
- NPI
- 1992295992
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 0401416141 (VA)
- Practice address
- 1025 Seneca Rd Ste B
Great Falls, VA 22066-1365 - Phone
- (571) 306-7676
- NPI assigned
- May 15, 2018
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in DC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20190925000704 | DC | Order and Referring Only - Dentist |
8628308236 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401416141 | VA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| All Smiles Dental, PLLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 0401416141 | VA | Yes |
Addresses
Primary practice location
1025 Seneca Rd Ste B
Great Falls, VA 22066-1365
Mailing address
350 N Clark St FL 6
Chicago, IL 60654-4712
Other providers in Great Falls, VA
- Kelsey Krause
- Leila I. Kump
- Chrystyna P. Kuzmowych
- Robert Rowan La Barre
- Lam Dental Arts PLLC
- Lauren G. Matini DDS PLLC
- Ralph Lazaro
- Tran Le
- Cathryn Chandler Lee
- David A Lipsey
All providers in Great Falls, VA · General Practice Dentistry in Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 17, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.