Healthcare Provider Details

I. General information

NPI: 1851404461
Provider Name (Legal Business Name): PAUL M LAMBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W FORT ST VETERANS AFFAIRS MEDICAL CENTER (11)
BOISE ID
83702-4501
US

IV. Provider business mailing address

5398 N BROOKMEADOW WAY
BOISE ID
83713-1480
US

V. Phone/Fax

Practice location:
  • Phone: 208-422-1301
  • Fax: 208-422-1157
Mailing address:
  • Phone: 208-938-1776
  • Fax: 208-938-1776

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30-01-6313
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: