Provider Demographics
NPI:1154660033
Name:LAMB, NICOLE LATISHA (DMD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:LATISHA
Last Name:LAMB
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2700 S UNIVERSITY DR STE 208
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3015
Mailing Address - Country:US
Mailing Address - Phone:954-252-2306
Mailing Address - Fax:
Practice Address - Street 1:2700 S UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33025-3015
Practice Address - Country:US
Practice Address - Phone:954-282-7085
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-12
Last Update Date:2017-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN20725122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program