Provider Demographics
NPI:1881706471
Name:LAMB, ROBERT MARTIN (DDS)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MARTIN
Last Name:LAMB
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 1:1004 MEDICAL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013
Mailing Address - Country:US
Mailing Address - Phone:405-348-8184
Mailing Address - Fax:405-348-5349
Practice Address - Street 1:1004 MEDICAL PARK BLVD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013
Practice Address - Country:US
Practice Address - Phone:405-348-8184
Practice Address - Fax:405-348-5349
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK48341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
731474414003OtherBLUE CROSS BLUE SHIELD
731474414003OtherBLUE CROSS BLUE SHIELD
OK243602003Medicare PIN
731474414003OtherBLUE CROSS BLUE SHIELD