Provider Demographics
NPI:1336738319
Name:HAM & LACY DENTAL GROUP, LLC
Entity Type:Organization
Organization Name:HAM & LACY DENTAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER AND MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:HAM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:520-404-9425
Mailing Address - Street 1:10425 N ORACLE RD STE 125
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9360
Mailing Address - Country:US
Mailing Address - Phone:520-404-9425
Mailing Address - Fax:
Practice Address - Street 1:10425 N ORACLE RD STE 125
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9360
Practice Address - Country:US
Practice Address - Phone:520-404-9425
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-13
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1659825255OtherNPI