Provider Demographics
NPI:1447433610
Name:COLEMAN, LANCE GREGORY (DDS)
Entity type:Individual
Prefix:
First Name:LANCE
Middle Name:GREGORY
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 BROADWAY
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79401-3277
Mailing Address - Country:US
Mailing Address - Phone:806-765-2605
Mailing Address - Fax:806-765-2604
Practice Address - Street 1:3301 CLOVIS RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-5155
Practice Address - Country:US
Practice Address - Phone:806-765-2611
Practice Address - Fax:806-771-7851
Is Sole Proprietor?:No
Enumeration Date:2007-12-11
Last Update Date:2010-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19294122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist