Healthcare Provider Details

I. General information

NPI: 1053861765
Provider Name (Legal Business Name): JORDAN A LAMBERTON DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2016
Last Update Date: 10/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3270 BEARD RD
NAPA CA
94558-3406
US

IV. Provider business mailing address

3270 BEARD RD
NAPA CA
94558-3406
US

V. Phone/Fax

Practice location:
  • Phone: 707-226-5555
  • Fax:
Mailing address:
  • Phone: 707-226-5555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number61054
License Number StateCA

VIII. Authorized Official

Name: JORDAN LAMBERTON
Title or Position: OWNER/CEO
Credential:
Phone: 707-226-5555