Provider Demographics
NPI:1487766259
Name:KISS, LANCE R (DMD)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:R
Last Name:KISS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:20 PINE STREET
Mailing Address - Street 2:
Mailing Address - City:PLAINVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06062
Mailing Address - Country:US
Mailing Address - Phone:860-747-2703
Mailing Address - Fax:860-747-4837
Practice Address - Street 1:20 PINE STREET
Practice Address - Street 2:
Practice Address - City:PLAINVILLE
Practice Address - State:CT
Practice Address - Zip Code:06062
Practice Address - Country:US
Practice Address - Phone:860-747-2703
Practice Address - Fax:860-747-4837
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT51191223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics