Provider Demographics
NPI:1134283187
Name:JANE K. LAMBERTUS, DDS, PLLC
Entity Type:Organization
Organization Name:JANE K. LAMBERTUS, DDS, PLLC
Other - Org Name:FRONTIER VILLAGE DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:KATHLEEN
Authorized Official - Last Name:LAMBERTUS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:928-541-1000
Mailing Address - Street 1:1781 E STATE ROUTE 69
Mailing Address - Street 2:STE 9
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5666
Mailing Address - Country:US
Mailing Address - Phone:928-541-1000
Mailing Address - Fax:928-778-2131
Practice Address - Street 1:1781 E STATE ROUTE 69
Practice Address - Street 2:STE 9
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5666
Practice Address - Country:US
Practice Address - Phone:928-541-1000
Practice Address - Fax:928-778-2131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty