Provider Demographics
NPI:1164546040
Name:COSMETIC, FAMILY & SPORTS DENTISTRY, PA
Entity Type:Organization
Organization Name:COSMETIC, FAMILY & SPORTS DENTISTRY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:952-922-9119
Mailing Address - Street 1:6545 FRANCE AVE S
Mailing Address - Street 2:SUITE 585
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-2131
Mailing Address - Country:US
Mailing Address - Phone:952-922-9119
Mailing Address - Fax:952-922-2628
Practice Address - Street 1:6545 FRANCE AVE S
Practice Address - Street 2:SUITE 585
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2131
Practice Address - Country:US
Practice Address - Phone:952-922-9119
Practice Address - Fax:952-922-2628
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty