MEDICARE: LANCE A SEBERG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	9803	FL

General Provider Information

NPI Number	:	1104974757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LANCE A SEBERG DDS

Provider Business Mailing Address
First Line	:	1905 BAYSHORE GARDENS PKWY
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4708
Country	:	US
Telephone Number	:	941-758-4747
Fax Number	:

Provider Business Practice Location Address
First Line	:	1905 BAYSHORE GARDENS PKWY
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34207-4708
Country	:	US
Telephone Number	:	941-758-4747
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	07/08/2007

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Directions to “ LANCE A SEBERG DDS” Practice Location

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