Provider Demographics
NPI:1093867657
Name:LAMBERT, TERRY A (DDS,PA)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:A
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:DDS,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:814 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2601
Mailing Address - Country:US
Mailing Address - Phone:601-268-1576
Mailing Address - Fax:601-268-2070
Practice Address - Street 1:814 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2601
Practice Address - Country:US
Practice Address - Phone:601-268-1576
Practice Address - Fax:601-268-2070
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1522721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00063490Medicaid