Provider Demographics
NPI:1780022004
Name:LAMM, BRENT ABRAHAM (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:ABRAHAM
Last Name:LAMM
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11121 CYPRESS TREE PT APT 304
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80921-7706
Mailing Address - Country:US
Mailing Address - Phone:801-721-3205
Mailing Address - Fax:
Practice Address - Street 1:6566 N MARKSHEFFEL RD
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80923-4252
Practice Address - Country:US
Practice Address - Phone:719-596-3113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-08
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO10647122300000X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist