NPIMap

Organization Active NPI

Glen Ellyn Pediatric Dentistry ,P.C..

  • Pediatric Dentistry
  • Glen Ellyn, IL
National Provider Identifier
1043390792
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
Legal business name
GLEN ELLYN PEDIATRIC DENTISTRY ,P.C..
Practice address
45 S Park Blvd
Suite #105
Glen Ellyn, IL 60137-6280
Phone
(630) 858-8755
Fax
(630) 858-6204
NPI assigned
Oct 17, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Martha A Lambert, R.D., M.P.H.
Title
Corp Secretary/Treasurer, Manager
Phone
(630) 858-8755

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X Primary

Addresses

Primary practice location

45 S Park Blvd
Suite #105
Glen Ellyn, IL 60137-6280

Mailing address

45 S Park Blvd
Suite #105
Glen Ellyn, IL 60137-6280
Phone (630) 858-8755

Other names 1

  • Lance Lambert D.D.S., P.C. Doing business as

National Provider Directory

National Provider Directory

Locations

45 S Park Blvd
Ste 105
Glen Ellyn, IL 60137
Phone (630) 756-5151

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1043390792",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "45 S PARK BLVD",
            "address_2": "SUITE #105",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376280",
            "telephone_number": "630-858-8755",
            "fax_number": "630-858-6204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 S PARK BLVD",
            "address_2": "SUITE #105",
            "city": "GLEN ELLYN",
            "state": "IL",
            "postal_code": "601376280",
            "telephone_number": "630-858-8755",
            "fax_number": "630-858-6204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GLEN ELLYN PEDIATRIC DENTISTRY ,P.C..",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "LAMBERT",
        "authorized_official_first_name": "MARTHA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CORP SECRETARY/TREASURER, MANAGER",
        "authorized_official_telephone_number": "630-858-8755",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "R.D., M.P.H."
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lance Lambert D.D.S., P.C.",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Glen Ellyn, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.