Provider Demographics
NPI:1629408489
Name:HAMILTON, LANCE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:
Last Name:HAMILTON
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 1:234 E 17TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3854
Mailing Address - Country:US
Mailing Address - Phone:949-650-6646
Mailing Address - Fax:949-650-2451
Practice Address - Street 1:234 E 17TH ST STE 107
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3854
Practice Address - Country:US
Practice Address - Phone:949-650-6646
Practice Address - Fax:949-650-2451
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29712122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist