Basic Information
| Provider Information | |||||||||
| NPI: | 1326486317 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | GERMAN | ||||||||
| FirstName: | LANCE | ||||||||
| MiddleName: | DANIEL | ||||||||
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| Credential: | DE60369954 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 409 CUSTER WAY SE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985013350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605708016 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 409 CUSTER WAY SE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | TUMWATER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985013350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3605708016 | ||||||||
| FaxNumber: | 3065708275 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2013 | ||||||||
| LastUpdateDate: | 03/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | DE60369954 | WA | Y | Dental Providers | Dentist |
No ID Information.