Provider Demographics
NPI:1730678798
Name:LANTSBERG, IGOR (DDS)
Entity Type:Individual
Prefix:
First Name:IGOR
Middle Name:
Last Name:LANTSBERG
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 1:1670 GUY ST APT E
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3763
Mailing Address - Country:US
Mailing Address - Phone:347-613-5082
Mailing Address - Fax:
Practice Address - Street 1:2840 5TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-6307
Practice Address - Country:US
Practice Address - Phone:619-291-4325
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty