Provider Demographics
NPI:1467641605
Name:DENTAL CORPORATION OF LANCE RYGG DDS
Entity Type:Organization
Organization Name:DENTAL CORPORATION OF LANCE RYGG DDS
Other - Org Name:POWAY FAMILY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:C
Authorized Official - Last Name:RYGG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-391-9300
Mailing Address - Street 1:2860 MICHELLE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:13616 POWAY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-6548
Practice Address - Country:US
Practice Address - Phone:858-391-9300
Practice Address - Fax:858-391-9449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-23
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty