Provider Demographics
NPI:1548277965
Name:LAMB, KENNETH MICHAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
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 1:909 N WILCOX DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5380
Mailing Address - Country:US
Mailing Address - Phone:423-247-5511
Mailing Address - Fax:423-247-4588
Practice Address - Street 1:909 N WILCOX DR
Practice Address - Street 2:SUITE A
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5380
Practice Address - Country:US
Practice Address - Phone:423-247-5511
Practice Address - Fax:423-247-4588
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS 41781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice