Provider Demographics
NPI:1851404461
Name:LAMBERT, PAUL M (DDS)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:M
Last Name:LAMBERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:5398 N BROOKMEADOW WAY
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83713-1480
Mailing Address - Country:US
Mailing Address - Phone:208-938-1776
Mailing Address - Fax:208-938-1776
Practice Address - Street 1:500 W FORT ST
Practice Address - Street 2:VETERANS AFFAIRS MEDICAL CENTER (11)
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4501
Practice Address - Country:US
Practice Address - Phone:208-422-1301
Practice Address - Fax:208-422-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2010-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-01-63131223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery