Provider Demographics
NPI:1619022969
Name:LAMBERT, JEFFREY T (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5532 W. HERRIMAN MAIN ST.
Mailing Address - Street 2:#210
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096
Mailing Address - Country:US
Mailing Address - Phone:801-446-9533
Mailing Address - Fax:385-695-5134
Practice Address - Street 1:5532 W. HERRIMAN MAIN ST.
Practice Address - Street 2:#210
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096
Practice Address - Country:US
Practice Address - Phone:801-446-9533
Practice Address - Fax:385-695-5134
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2020-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT3486271223G0001X
UT348627-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice