Healthcare Provider Details

I. General information

NPI: 1063485829
Provider Name (Legal Business Name): DEREK H LAMB DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3501 N SCOTTSDALE RD STE 226
SCOTTSDALE AZ
85251-5630
US

IV. Provider business mailing address

3501 N SCOTTSDALE RD STE 226
SCOTTSDALE AZ
85251-5630
US

V. Phone/Fax

Practice location:
  • Phone: 480-941-5005
  • Fax: 480-946-0268
Mailing address:
  • Phone: 480-941-5005
  • Fax: 480-946-0268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number11990
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number51977
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number43835
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number07855
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: