Provider Demographics
NPI:1760823934
Name:LAMB, MICHAEL F (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:F
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 1:1160 VARNUM ST NE STE 6
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2110
Mailing Address - Country:US
Mailing Address - Phone:202-269-7103
Mailing Address - Fax:202-635-7145
Practice Address - Street 1:1160 VARNUM ST NE STE 6
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2110
Practice Address - Country:US
Practice Address - Phone:202-269-7103
Practice Address - Fax:202-635-7145
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-16
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN4260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC023860400Medicaid