Provider Demographics
NPI:1598944290
Name:EDMOND ORAL AND MAXILLOFACIAL SURGERY
Entity Type:Organization
Organization Name:EDMOND ORAL AND MAXILLOFACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-348-8184
Mailing Address - Street 1:1004 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3025
Mailing Address - Country:US
Mailing Address - Phone:405-348-8184
Mailing Address - Fax:405-348-5349
Practice Address - Street 1:1004 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3025
Practice Address - Country:US
Practice Address - Phone:405-348-8184
Practice Address - Fax:405-348-5349
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-30
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK=========OtherEMPLOYER IDENTIFICATION NUMBER (EIN)
300522204Medicare PIN