Provider Demographics
NPI:1497597264
Name:NOERENBERG, LANCE ROBERT (DDS)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ROBERT
Last Name:NOERENBERG
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 1:1250 E MADISON ST.
Mailing Address - Street 2:APT 318
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-8933
Mailing Address - Country:US
Mailing Address - Phone:219-678-0003
Mailing Address - Fax:
Practice Address - Street 1:11157 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-2901
Practice Address - Country:US
Practice Address - Phone:813-641-4921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-11
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL29052122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist