Provider Demographics
NPI:1801251574
Name:MARK A LAMB DDS PC
Entity type:Organization
Organization Name:MARK A LAMB DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:810-724-2365
Mailing Address - Street 1:250 E CAPAC RD
Mailing Address - Street 2:
Mailing Address - City:IMLAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48444-1114
Mailing Address - Country:US
Mailing Address - Phone:810-724-2365
Mailing Address - Fax:810-821-0815
Practice Address - Street 1:250 E CAPAC RD
Practice Address - Street 2:
Practice Address - City:IMLAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48444-1114
Practice Address - Country:US
Practice Address - Phone:810-724-2365
Practice Address - Fax:810-821-0815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty