Healthcare Provider Details

I. General information

NPI: 1295107696
Provider Name (Legal Business Name): RICHARD LAMB D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2015
Last Update Date: 10/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N MAIN ST
ANNA IL
62906-1652
US

IV. Provider business mailing address

1000 N MAIN ST
ANNA IL
62906-1652
US

V. Phone/Fax

Practice location:
  • Phone: 618-833-5161
  • Fax: 618-833-4191
Mailing address:
  • Phone: 618-833-5161
  • Fax: 618-833-4191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number019.015214
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: