Healthcare Provider Details

I. General information

NPI: 1619022969
Provider Name (Legal Business Name): JEFFREY T LAMBERT DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2007
Last Update Date: 10/13/2020
Certification Date: 10/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5532 W. HERRIMAN MAIN ST. #210
HERRIMAN UT
84096
US

IV. Provider business mailing address

5532 W. HERRIMAN MAIN ST. #210
HERRIMAN UT
84096
US

V. Phone/Fax

Practice location:
  • Phone: 801-446-9533
  • Fax: 385-695-5134
Mailing address:
  • Phone: 801-446-9533
  • Fax: 385-695-5134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number348627
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number348627-9922
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: