Basic Information
Provider Information
NPI: 1003829052
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: LAMBRIDIS
FirstName: DEAN
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential: DDS
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1760 E AVENIDA DE LOS ARBOLES
Address2: STE. A
City: THOUSAND OAKS
State: CA
PostalCode: 913621391
CountryCode: US
TelephoneNumber: 8054935200
FaxNumber: 8054935205
Practice Location
Address1: 2860 MICHELLE
Address2: 2ND FLOOR
City: IRVINE
State: CA
PostalCode: 926061009
CountryCode: US
TelephoneNumber: 7145083600
FaxNumber: 7143682092
Other Information
ProviderEnumerationDate: 08/14/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1223G0001X51199CAY Dental ProvidersDentistGeneral Practice

No ID Information.


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