Provider Demographics
NPI:1720379555
Name:LANCE A. ALBRECHTSEN, DDS, MS, INC.
Entity Type:Organization
Organization Name:LANCE A. ALBRECHTSEN, DDS, MS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:ADAM
Authorized Official - Last Name:ALBRECHTSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:801-479-9800
Mailing Address - Street 1:5677 S 1475 E
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84403-7032
Mailing Address - Country:US
Mailing Address - Phone:801-479-9800
Mailing Address - Fax:801-475-0224
Practice Address - Street 1:5677 S 1475 E
Practice Address - Street 2:SUITE 2A
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84403-7032
Practice Address - Country:US
Practice Address - Phone:801-479-9800
Practice Address - Fax:801-475-0224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328324-9921223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty