Provider Demographics
NPI:1376970848
Name:TATUM RANCH DENTAL CARE
Entity Type:Organization
Organization Name:TATUM RANCH DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:LAMBORN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:480-563-5237
Mailing Address - Street 1:PO BOX 71549
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-1010
Mailing Address - Country:US
Mailing Address - Phone:480-563-5237
Mailing Address - Fax:480-513-9340
Practice Address - Street 1:29834 N CAVE CREEK RD
Practice Address - Street 2:#138
Practice Address - City:CAVE CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85331-5836
Practice Address - Country:US
Practice Address - Phone:480-563-5237
Practice Address - Fax:480-513-9340
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3898122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty