Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 30.021713 | OH |
NPI | 1003988874 |
---|---|
Provider Name | Dr. Lance T. Vernon |
First Address | Cleveland Heights, OH 44118-3533 |
Second Address | Cleveland Heights, OH 44118-3533 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/07/2007 |