Healthcare Provider Details

I. General information

NPI: 1740252949
Provider Name (Legal Business Name): LANCE JEFF ADELSON D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2818 OCEAN AVE SUITE 3
BROOKLYN NY
11235-3170
US

IV. Provider business mailing address

2818 OCEAN AVE SUITE 3
BROOKLYN NY
11235-3170
US

V. Phone/Fax

Practice location:
  • Phone: 718-769-0777
  • Fax: 718-769-0778
Mailing address:
  • Phone: 718-769-0777
  • Fax: 718-769-0778

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number030952
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberD11966
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: