MEDICARE: JOEL LAMBERT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	17427	TX

General Provider Information

NPI Number	:	1891855805
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOEL LAMBERT

Provider Business Mailing Address
First Line	:	1218 SW MILITARY DR
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78221-1535
Country	:	US
Telephone Number	:	210-653-4867
Fax Number	:

Provider Business Practice Location Address
First Line	:	6909 N LOOP 1604 E
Second Line	:	SUTIE 1010
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-5317
Country	:	US
Telephone Number	:	210-653-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	07/08/2007

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