Provider Demographics
NPI:1356407779
Name:DEREK H. LAMB, DMD, MD, PLLC
Entity type:Organization
Organization Name:DEREK H. LAMB, DMD, MD, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER / ORAL & MAXILLOFACIAL SURGEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:H
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MD
Authorized Official - Phone:480-941-5005
Mailing Address - Street 1:3501 N SCOTTSDALE RD
Mailing Address - Street 2:SUITE 226
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5648
Mailing Address - Country:US
Mailing Address - Phone:480-941-5005
Mailing Address - Fax:
Practice Address - Street 1:3501 N SCOTTSDALE RD
Practice Address - Street 2:SUITE 226
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5648
Practice Address - Country:US
Practice Address - Phone:480-941-5005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-29
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ22021223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty