MEDICARE: DR. BRENT ABRAHAM LAMM DDS, MSD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	10647	CO
2	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	10647	CO

General Provider Information

NPI Number	:	1780022004
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRENT ABRAHAM LAMM DDS, MSD

Provider Business Mailing Address
First Line	:	11121 CYPRESS TREE PT APT 304
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80921-7706
Country	:	US
Telephone Number	:	801-721-3205
Fax Number	:

Provider Business Practice Location Address
First Line	:	6566 N MARKSHEFFEL RD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80923-4252
Country	:	US
Telephone Number	:	719-596-3113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2013
Last Update Date	:	09/30/2024

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