Individual
LANCE ANTHONY WHITE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1302 HOLLY AVE, IMPERIAL BEACH, CA 91932-3709
(619) 451-0610
Mailing address
1302 HOLLY AVE, IMPERIAL BEACH, CA 91932-3709
(619) 451-0610
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
82300
CA
Other
Enumeration date
04/29/2019
Last updated
04/29/2019
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