Provider Demographics
NPI:1730129180
Name:LAMBERT, BRYANT (DDS)
Entity Type:Individual
Prefix:
First Name:BRYANT
Middle Name:
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 1:1542 DRESDEN DR NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30319-3567
Mailing Address - Country:US
Mailing Address - Phone:678-923-2793
Mailing Address - Fax:
Practice Address - Street 1:2521 VESTAL PKWY W
Practice Address - Street 2:
Practice Address - City:VESTAL
Practice Address - State:NY
Practice Address - Zip Code:13850-1056
Practice Address - Country:US
Practice Address - Phone:607-754-2217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN012218122300000X
NY50049877122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist