Provider Demographics
NPI:1023360120
Name:JEFFERSON AND LAMBRIDIS DENTAL CORPORATION
Entity Type:Organization
Organization Name:JEFFERSON AND LAMBRIDIS DENTAL CORPORATION
Other - Org Name:GOSFORD VILLAGE DENTAL GROUP AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:
Authorized Official - Last Name:JEFFERSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-588-2065
Mailing Address - Street 1:2860 MICHELLE FL 2
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1008
Mailing Address - Country:US
Mailing Address - Phone:714-368-2084
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:5353 GOSFORD RD STE 103
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93313-4996
Practice Address - Country:US
Practice Address - Phone:661-558-2065
Practice Address - Fax:661-588-2137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty