Provider Demographics
NPI:1710326665
Name:DEHNE, LANCE WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:WILLIAM
Last Name:DEHNE
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 1:4391 CANAL AVE SW
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANDVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49418-2680
Mailing Address - Country:US
Mailing Address - Phone:616-530-3900
Mailing Address - Fax:616-530-5919
Practice Address - Street 1:4391 CANAL AVE SW
Practice Address - Street 2:SUITE A
Practice Address - City:GRANDVILLE
Practice Address - State:MI
Practice Address - Zip Code:49418-2680
Practice Address - Country:US
Practice Address - Phone:616-530-3900
Practice Address - Fax:616-530-5919
Is Sole Proprietor?:No
Enumeration Date:2013-06-24
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901021034122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist