Healthcare Provider Details

I. General information

NPI: 1023025582
Provider Name (Legal Business Name): LANCE LEGE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

904 N CUSHING AVE
KAPLAN LA
70548-2617
US

IV. Provider business mailing address

904 N CUSHING AVE
KAPLAN LA
70548-2617
US

V. Phone/Fax

Practice location:
  • Phone: 337-643-7766
  • Fax: 337-643-7222
Mailing address:
  • Phone: 337-643-7766
  • Fax: 337-643-7222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberLA5485
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: