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General NPI Number Information
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NPI Number | 1366701096
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Entity Type | Organization
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Legal Business Name | LANCE RYGG PROFESSIONAL DENTAL CORPORATION
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Dates
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Enumeration Date | 05/15/2012
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Last Update Date | 05/15/2012
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Provider Practice Location Address
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Address Line | 5638 MISSION CENTER RD SUITE 107
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City | SAN DIEGO
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State | CA
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Zip | 92108-4348
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Country | US
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Telephone | 619-220-0159
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Fax | 619-220-0162
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE DRIVE 2ND FLOOR
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City | IRVINE
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State | CA
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Zip | 92606
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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Authorized Official
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Title or Position | OWNER
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Name | LANCE C RYGG
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Credential | D.D.S.
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Telephone | 619-220-0159
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 30251
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License Number State | CA
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