Provider Demographics
NPI:1407178593
Name:MARK C. LAMBERT, DMD PC
Entity Type:Organization
Organization Name:MARK C. LAMBERT, DMD PC
Other - Org Name:GOODING FAMILY AND COSMETIC DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-934-8080
Mailing Address - Street 1:325 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODING
Mailing Address - State:ID
Mailing Address - Zip Code:83330-1302
Mailing Address - Country:US
Mailing Address - Phone:208-934-8080
Mailing Address - Fax:208-934-9756
Practice Address - Street 1:325 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODING
Practice Address - State:ID
Practice Address - Zip Code:83330-1302
Practice Address - Country:US
Practice Address - Phone:208-934-8080
Practice Address - Fax:208-934-9756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD34151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty