Provider Demographics
NPI:1790113892
Name:ALBRECHTSEN, LANCE (DMD, MS)
Entity Type:Individual
Prefix:
First Name:LANCE
Middle Name:
Last Name:ALBRECHTSEN
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5677 S 1475 E
Mailing Address - Street 2:
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:
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
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT328324-99221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics