Provider Demographics
NPI:1336417104
Name:JEFFREY T. LAMBERT
Entity Type:Organization
Organization Name:JEFFREY T. LAMBERT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:T
Authorized Official - Last Name:LAMBERT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:801-302-0222
Mailing Address - Street 1:5734 W 13400 S
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HERRIMAN
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6953
Mailing Address - Country:US
Mailing Address - Phone:801-302-0222
Mailing Address - Fax:801-302-0610
Practice Address - Street 1:5734 W 13400 S
Practice Address - Street 2:SUITE 100
Practice Address - City:HERRIMAN
Practice Address - State:UT
Practice Address - Zip Code:84096-6953
Practice Address - Country:US
Practice Address - Phone:801-302-0222
Practice Address - Fax:801-302-0610
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT348627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty