Provider Demographics
NPI:1992845473
Name:LAMP, MICHAEL AARON (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:AARON
Last Name:LAMP
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 1:4511 SUN N LAKE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33872-2169
Mailing Address - Country:US
Mailing Address - Phone:863-385-1911
Mailing Address - Fax:863-385-2869
Practice Address - Street 1:4511 SUN N LAKE BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33872-2169
Practice Address - Country:US
Practice Address - Phone:863-385-1911
Practice Address - Fax:863-385-2869
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL112981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice