Healthcare Provider Details

I. General information

NPI: 1154861227
Provider Name (Legal Business Name): MICHAEL ZACHARY LAMB DMD, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2017
Last Update Date: 09/03/2024
Certification Date: 09/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31ST MEDICAL GROUP/SGST UNIT 6180
APO AE
09604
US

IV. Provider business mailing address

31ST MEDICAL GROUP/SGST UNIT 6180
APO AE
09604
US

V. Phone/Fax

Practice location:
  • Phone: 21-029-2625
  • Fax:
Mailing address:
  • Phone: 314-632-5060
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number9001
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number9001
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: