Provider Demographics
NPI:1942979372
Name:LAMP, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:LAMP
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 DECOY LN
Mailing Address - Street 2:
Mailing Address - City:HALLSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75650
Mailing Address - Country:US
Mailing Address - Phone:714-757-9815
Mailing Address - Fax:
Practice Address - Street 1:900 E END BLVD N STE 200
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:TX
Practice Address - Zip Code:75670-2166
Practice Address - Country:US
Practice Address - Phone:903-935-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-09
Last Update Date:2021-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX377941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice