Healthcare Provider Details

I. General information

NPI: 1447433610
Provider Name (Legal Business Name): LANCE GREGORY COLEMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 07/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 CLOVIS RD
LUBBOCK TX
79415-5155
US

IV. Provider business mailing address

1313 BROADWAY SUITE 5
LUBBOCK TX
79401-3277
US

V. Phone/Fax

Practice location:
  • Phone: 806-765-2611
  • Fax: 806-771-7851
Mailing address:
  • Phone: 806-765-2605
  • Fax: 806-765-2604

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19294
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: