Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 021532 | PA |
NPI | 1073847521 |
---|---|
Provider Name | Lance M Coben |
First Address | Lansdale, PA 19446-1052 |
Second Address | Lansdale, PA 19446-1052 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/09/2009 |
Last Update Date | 30/09/2009 |