Healthcare Provider Details

I. General information

NPI: 1053497768
Provider Name (Legal Business Name): LANCE LOREN WHETTEN DDS MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4540 S PECOS RD
LAS VEGAS NV
89121-5923
US

IV. Provider business mailing address

4540 S PECOS RD
LAS VEGAS NV
89121-5923
US

V. Phone/Fax

Practice location:
  • Phone: 702-436-0999
  • Fax: 702-436-2746
Mailing address:
  • Phone: 702-436-0999
  • Fax: 702-436-2746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number937, S3-28
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: