Provider Demographics
NPI:1780643106
Name:LAMBERTUS, JANE KATHLEEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:KATHLEEN
Last Name:LAMBERTUS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1781 E HIGHWAY 69
Mailing Address - Street 2:STE 9
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5666
Mailing Address - Country:US
Mailing Address - Phone:928-541-1000
Mailing Address - Fax:928-778-2131
Practice Address - Street 1:1781 E HIGHWAY 69
Practice Address - Street 2:STE 9
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5666
Practice Address - Country:US
Practice Address - Phone:928-541-1000
Practice Address - Fax:928-778-2131
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ5672122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist