Provider Demographics
NPI:1740331917
Name:LANCE, V GLENN
Entity type:Individual
Prefix:DR
First Name:V
Middle Name:GLENN
Last Name:LANCE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 N MAIN ST STE 1
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-3948
Mailing Address - Country:US
Mailing Address - Phone:870-845-1263
Mailing Address - Fax:
Practice Address - Street 1:700 N MAIN ST STE 1
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-3948
Practice Address - Country:US
Practice Address - Phone:870-845-1263
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR28501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice