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General NPI Number Information
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NPI Number | 1730532870
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Entity Type | Individual
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Provider Name | LANCE PEERY D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 07/13/2016
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Last Update Date | 07/13/2016
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Provider Practice Location Address
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Address Line | 1101 W TOKAY ST #1
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City | LODI
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State | CA
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Zip | 95240-3842
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Country | US
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Telephone | 209-334-2821
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Fax |
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Provider Business Mailing Address
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Address Line | 540 VIRGINIA AVE
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City | LODI
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State | CA
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Zip | 95242-3445
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 100347
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License Number State | CA
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