Healthcare Provider Details

I. General information

NPI: 1700288792
Provider Name (Legal Business Name): RAMIRO LAMBARIA III D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 01/15/2024
Certification Date: 01/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 CHERRY ST SE STE 1
GRAND RAPIDS MI
49503-4658
US

IV. Provider business mailing address

5303 E CORTLAND BLVD APT K08
FLAGSTAFF AZ
86004-9580
US

V. Phone/Fax

Practice location:
  • Phone: 616-458-8593
  • Fax:
Mailing address:
  • Phone: 810-347-7117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901021412
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: