Provider Demographics
NPI:1255477337
Name:LAMBERTY, MARY M (DH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:LAMBERTY
Suffix:
Gender:F
Credentials:DH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 N. ORANGE BLOSSOM TRAIL
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32805
Mailing Address - Country:US
Mailing Address - Phone:407-428-1672
Mailing Address - Fax:407-481-8638
Practice Address - Street 1:232 N. ORANGE BLOSSOM TRAIL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805
Practice Address - Country:US
Practice Address - Phone:407-428-1672
Practice Address - Fax:407-481-8638
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH 6887124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDH 6887OtherDENTAL HYGIENIST LICENSE