Provider Demographics
NPI:1447405014
Name:VANDER GIESSEN, LANCE ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ERIC
Last Name:VANDER GIESSEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3628 MERIDIAN ST STE 2A
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1735
Mailing Address - Country:US
Mailing Address - Phone:360-671-6333
Mailing Address - Fax:360-671-1730
Practice Address - Street 1:3628 MERIDIAN ST STE 2A
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1735
Practice Address - Country:US
Practice Address - Phone:360-671-6333
Practice Address - Fax:360-671-1730
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-24
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60035258122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice