Provider Demographics
NPI:1689819674
Name:LANCE R KISS DMD
Entity Type:Organization
Organization Name:LANCE R KISS DMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHDONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KISS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:860-747-2703
Mailing Address - Street 1:20 PINE ST
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062-1941
Mailing Address - Country:US
Mailing Address - Phone:860-747-2703
Mailing Address - Fax:860-747-4837
Practice Address - Street 1:20 PINE ST
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062-1941
Practice Address - Country:US
Practice Address - Phone:860-747-2703
Practice Address - Fax:860-747-4837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-05
Last Update Date:2008-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty