Provider Demographics
NPI:1275754996
Name:LACOMBE, JAN (DMD)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:
Last Name:LACOMBE
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 W EL NORTE PKWY
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92026-3983
Mailing Address - Country:US
Mailing Address - Phone:760-489-5545
Mailing Address - Fax:760-489-5546
Practice Address - Street 1:500 W EL NORTE PKWY
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92026-3983
Practice Address - Country:US
Practice Address - Phone:760-489-5545
Practice Address - Fax:760-489-5546
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA440001223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics