Provider Demographics
NPI:1700990686
Name:LAMP, DENNIS W (DDS)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:W
Last Name:LAMP
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 1:2235 S 825 E
Mailing Address - Street 2:
Mailing Address - City:AVILLA
Mailing Address - State:IN
Mailing Address - Zip Code:46710-9735
Mailing Address - Country:US
Mailing Address - Phone:260-897-2555
Mailing Address - Fax:
Practice Address - Street 1:2235 S 825 E
Practice Address - Street 2:
Practice Address - City:AVILLA
Practice Address - State:IN
Practice Address - Zip Code:46710-9735
Practice Address - Country:US
Practice Address - Phone:260-897-2555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2022-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12007359A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100190800Medicaid