Provider Demographics
NPI:1942416060
Name:LAMB, BRYAN H (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:H
Last Name:LAMB
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5898 S. QUAMASH WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83716-0000
Mailing Address - Country:US
Mailing Address - Phone:208-395-1000
Mailing Address - Fax:208-395-1019
Practice Address - Street 1:4255 N EAGLE RD STE 102
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83713-0701
Practice Address - Country:US
Practice Address - Phone:208-344-6300
Practice Address - Fax:082-938-9906
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2493122300000X
IDD-3935122300000X
ORD-6505122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID8076727Medicaid