Provider Demographics
NPI:1619046638
Name:SMITH, LANCE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:E
Last Name:SMITH
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 1:12297 PENNSYLVANIA STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241
Mailing Address - Country:US
Mailing Address - Phone:303-920-4199
Mailing Address - Fax:303-920-4203
Practice Address - Street 1:12297 PENNSYLVANIA ST
Practice Address - Street 2:SUITE 1
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241-3165
Practice Address - Country:US
Practice Address - Phone:303-920-4199
Practice Address - Fax:303-920-4203
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO69721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice