Provider Demographics
NPI:1417046582
Name:LAMB, RANDALL DALE
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:DALE
Last Name:LAMB
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8810 TARTER AVE.
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79121
Mailing Address - Country:US
Mailing Address - Phone:806-351-0600
Mailing Address - Fax:
Practice Address - Street 1:8810 TARTER AVE.
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79121
Practice Address - Country:US
Practice Address - Phone:806-351-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice