Provider Demographics
NPI:1043390792
Name:GLEN ELLYN PEDIATRIC DENTISTRY ,P.C..
Entity Type:Organization
Organization Name:GLEN ELLYN PEDIATRIC DENTISTRY ,P.C..
Other - Org Name:LANCE LAMBERT D.D.S., P.C.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORP SECRETARY/TREASURER, MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:A
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:RD, MPH
Authorized Official - Phone:630-858-8755
Mailing Address - Street 1:45 S PARK BLVD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:GLEN ELLYN
Mailing Address - State:IL
Mailing Address - Zip Code:60137-6280
Mailing Address - Country:US
Mailing Address - Phone:630-858-8755
Mailing Address - Fax:630-858-6204
Practice Address - Street 1:45 S PARK BLVD
Practice Address - Street 2:SUITE #105
Practice Address - City:GLEN ELLYN
Practice Address - State:IL
Practice Address - Zip Code:60137-6280
Practice Address - Country:US
Practice Address - Phone:630-858-8755
Practice Address - Fax:630-858-6204
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty