Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 20644 | OH |
NPI | 1063558260 |
---|---|
Provider Name | Dennis Lambert |
First Address | Mason, OH 45040-9671 |
Second Address | Mason, OH 45040-9671 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2056153 | (05) | OH |