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General NPI Number Information
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NPI Number | 1376970848
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Entity Type | Organization
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Legal Business Name | TATUM RANCH DENTAL CARE
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Dates
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Enumeration Date | 09/30/2013
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Last Update Date | 09/30/2013
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Provider Practice Location Address
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Address Line | 29834 N CAVE CREEK RD #138
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City | CAVE CREEK
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State | AZ
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Zip | 85331-5836
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Country | US
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Telephone | 480-563-5237
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Fax | 480-513-9340
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Provider Business Mailing Address
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Address Line | PO BOX 71549
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City | PHOENIX
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State | AZ
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Zip | 85050-1010
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Country | US
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Telephone | 480-563-5237
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Fax | 480-513-9340
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. KEITH DOUGLAS LAMBORN
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Credential | D.D.S.
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Telephone | 480-563-5237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 3898
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License Number State | AZ
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