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General NPI Number Information
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NPI Number | 1467894915
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Entity Type | Individual
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Provider Name | MARK LAMBORN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/25/2013
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 3960 E RIGGS RD STE 5
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City | CHANDLER
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State | AZ
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Zip | 85249-5411
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Country | US
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Telephone | 480-566-8349
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Fax |
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Provider Business Mailing Address
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Address Line | 3453 E ANIKA CT
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City | GILBERT
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State | AZ
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Zip | 85298-4217
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Country | US
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Telephone | 480-294-0098
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 62489
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D9977
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License Number State | AZ
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