Provider Demographics
NPI:1003988874
Name:VERNON, LANCE T (DMD, MPH)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:T
Last Name:VERNON
Suffix:
Gender:M
Credentials:DMD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2995 ESSEX RD
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3533
Mailing Address - Country:US
Mailing Address - Phone:216-371-9509
Mailing Address - Fax:
Practice Address - Street 1:2995 ESSEX RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44118-3533
Practice Address - Country:US
Practice Address - Phone:216-371-9509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.021713122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist