Healthcare Provider Details

I. General information

NPI: 1407940844
Provider Name (Legal Business Name): KURT P. LAMBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 01/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5909 ALICE NE
ALBUQUERQUE NM
87110
US

IV. Provider business mailing address

4101 MORRIS ST NE STE D
ALBUQUERQUE NM
87111-3605
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-6388
  • Fax: 505-254-2461
Mailing address:
  • Phone: 505-294-2974
  • Fax: 505-291-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDD1632
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: