MEDICARE: LANCE DAVID STARLING DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	9363273-9923	UT

General Provider Information

NPI Number	:	1255024816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE DAVID STARLING DMD

Provider Business Mailing Address
First Line	:	4775 W DAYBREAK PKWY STE 103
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-5139
Country	:	US
Telephone Number	:	801-206-4385
Fax Number	:

Provider Business Practice Location Address
First Line	:	5087 W LAKE TERRACE AVE
Second Line	:
City	:	SOUTH JORDAN
State	:	UT
Zip	:	84009-6205
Country	:	US
Telephone Number	:	801-360-4770
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2023
Last Update Date	:	05/31/2023

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