Provider Demographics
NPI:1083826598
Name:LAMB, EDWIN L (DMD)
Entity Type:Individual
Prefix:
First Name:EDWIN
Middle Name:L
Last Name:LAMB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4837 OAK ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-4904
Mailing Address - Country:US
Mailing Address - Phone:229-245-7830
Mailing Address - Fax:
Practice Address - Street 1:3227 N OAK STREET EXT
Practice Address - Street 2:SUITE B
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-7416
Practice Address - Country:US
Practice Address - Phone:229-247-2300
Practice Address - Fax:229-247-2324
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0104071223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics