Provider Demographics
NPI:1710906300
Name:LANCE, CHRISTOPHER MICHAEL (DMD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHAEL
Last Name:LANCE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:PA
Mailing Address - Zip Code:15537-7028
Mailing Address - Country:US
Mailing Address - Phone:814-623-1022
Mailing Address - Fax:
Practice Address - Street 1:138 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-7028
Practice Address - Country:US
Practice Address - Phone:814-623-1022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030151L1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAP00194477OtherMEDICARE RAILROAD
PA65950OtherGEISINGER HEALTH PLAN
PA217998OtherUPMC HEALTH PLAN
PA217998OtherUPMC HEALTH PLAN
PA65950OtherGEISINGER HEALTH PLAN