Provider Demographics
NPI:1578781142
Name:DUNHAM, LANCE R
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:R
Last Name:DUNHAM
Suffix:
Gender:M
Credentials:
Other - Prefix:DR
Other - First Name:LANCE
Other - Middle Name:ROBERT
Other - Last Name:DUNHAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10172 MASON AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-3301
Mailing Address - Country:US
Mailing Address - Phone:818-885-0088
Mailing Address - Fax:818-885-1232
Practice Address - Street 1:10172 MASON AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-3301
Practice Address - Country:US
Practice Address - Phone:818-885-0088
Practice Address - Fax:818-885-1232
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA335691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice