Provider Demographics
NPI:1326486317
Name:GERMAN, LANCE DANIEL (DE60369954)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:DANIEL
Last Name:GERMAN
Suffix:
Gender:M
Credentials:DE60369954
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:409 CUSTER WAY SE
Mailing Address - Street 2:SUITE C
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98501-3350
Mailing Address - Country:US
Mailing Address - Phone:360-570-8016
Mailing Address - Fax:
Practice Address - Street 1:409 CUSTER WAY SE
Practice Address - Street 2:SUITE C
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98501-3350
Practice Address - Country:US
Practice Address - Phone:360-570-8016
Practice Address - Fax:306-570-8275
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-12
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60369954122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist