Provider Demographics
NPI:1740664333
Name:LAMBOURNE, CRAIG (DDS)
Entity type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:
Last Name:LAMBOURNE
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 1:3412 W WILLOW KNOLLS DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61614-1009
Mailing Address - Country:US
Mailing Address - Phone:309-690-3262
Mailing Address - Fax:309-693-8295
Practice Address - Street 1:3412 W WILLOW KNOLLS DR
Practice Address - Street 2:SUITE A
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61614-1009
Practice Address - Country:US
Practice Address - Phone:309-690-3262
Practice Address - Fax:309-693-8295
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-14
Last Update Date:2016-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA646391223G0001X
IL0190305941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice