Bradley Lance, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2019019262 Issued in MO

Practice address

7766 Winghaven Blvd
O Fallon, MO 63368-3601

Phone

(636) 561-4117

NPI assigned

Jun 8, 2019

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bradley D Lance, DDS PC

  • Dental Clinic/Center
  • Festus, MO
  • NPI 1891529160
  NPD Authorized official
• Eric Hurtte D.M.D, P.C.

  • Preferred Provider Organization
  • O Fallon, MO
  • NPI 1508416967
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 8, 2019.

{
    "created_epoch": "1559952000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1559952000000",
    "number": "1356900872",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13510 BECKER PLACE DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631284198",
            "telephone_number": "314-605-3402"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7766 WINGHAVEN BLVD",
            "city": "O FALLON",
            "state": "MO",
            "postal_code": "633683601",
            "telephone_number": "636-561-4117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANCE",
        "first_name": "BRADLEY",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-06-08",
        "last_updated": "2019-06-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2019019262",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in O Fallon, MO
• Dentist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.