Provider Demographics
NPI:1780865162
Name:JERRY E. LAMBERT, JR., D.D.S., P.C.
Entity Type:Organization
Organization Name:JERRY E. LAMBERT, JR., D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:E
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-663-1207
Mailing Address - Street 1:301 S COURT ST
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-3960
Mailing Address - Country:US
Mailing Address - Phone:219-663-1207
Mailing Address - Fax:219-663-6474
Practice Address - Street 1:301 S COURT ST
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-3960
Practice Address - Country:US
Practice Address - Phone:219-663-1207
Practice Address - Fax:219-663-6474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN54001561A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty