Provider Demographics
NPI:1629732797
Name:VIERNES, LANCE (DDS)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:VIERNES
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 1:185 PROSPECT AVE APT 14M
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-2265
Mailing Address - Country:US
Mailing Address - Phone:732-421-6185
Mailing Address - Fax:
Practice Address - Street 1:2115 ROUTE 10 WEST
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-8403
Practice Address - Country:US
Practice Address - Phone:908-964-5406
Practice Address - Fax:908-964-7298
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-26
Last Update Date:2021-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028686001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice