Provider Demographics
NPI:1356520852
Name:WEST, LANCE EDWARD (DMD, MS, PC)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:EDWARD
Last Name:WEST
Suffix:
Gender:M
Credentials:DMD, MS, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1322 E MCANDREWS RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-6177
Mailing Address - Country:US
Mailing Address - Phone:541-770-1176
Mailing Address - Fax:541-770-1501
Practice Address - Street 1:1322 E MCANDREWS RD
Practice Address - Street 2:SUITE 102
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-6177
Practice Address - Country:US
Practice Address - Phone:541-770-1176
Practice Address - Fax:541-770-1501
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORD80081223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics