Provider Demographics
NPI:1568686475
Name:LANCE, LEROY (DDS MS)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:
Last Name:LANCE
Suffix:
Gender:M
Credentials:DDS MS
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:18102 IRVINE BLVD
Mailing Address - Street 2:STE 205
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3402
Mailing Address - Country:US
Mailing Address - Phone:714-731-5656
Mailing Address - Fax:714-731-2607
Practice Address - Street 1:18102 IRVINE BLVD
Practice Address - Street 2:STE 205
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3402
Practice Address - Country:US
Practice Address - Phone:714-731-5656
Practice Address - Fax:714-731-2607
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA150751223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics