Provider Demographics
NPI:1427262526
Name:VILLAGE PLAZA DENTAL
Entity type:Organization
Organization Name:VILLAGE PLAZA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LAMB
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:541-343-3822
Mailing Address - Street 1:4750 VILLAGE PLAZA LOOP
Mailing Address - Street 2:#201
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-6601
Mailing Address - Country:US
Mailing Address - Phone:541-343-3822
Mailing Address - Fax:541-343-3824
Practice Address - Street 1:4750 VILLAGE PLAZA LOOP
Practice Address - Street 2:#201
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-6601
Practice Address - Country:US
Practice Address - Phone:541-343-3822
Practice Address - Fax:541-343-3824
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JAY C. LAMB, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-09
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5637122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty