Provider Demographics
NPI:1700018801
Name:LAMB, FREDERICK BROCK (DDS)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:BROCK
Last Name:LAMB
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 PALMA RD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-6785
Mailing Address - Country:US
Mailing Address - Phone:928-763-2516
Mailing Address - Fax:
Practice Address - Street 1:1467 PALMA RD
Practice Address - Street 2:SUITE 3
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-6785
Practice Address - Country:US
Practice Address - Phone:928-763-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-22
Last Update Date:2009-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice