Provider Demographics
NPI:1285756379
Name:RASMUSSEN, LANCE OSCAR (DMD INC)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:OSCAR
Last Name:RASMUSSEN
Suffix:
Gender:M
Credentials:DMD INC
Other - Prefix:
Other - First Name:LANCE
Other - Middle Name:O
Other - Last Name:RASMUSSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD INC
Mailing Address - Street 1:330 IGNACIO BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949
Mailing Address - Country:US
Mailing Address - Phone:415-883-4631
Mailing Address - Fax:415-883-0591
Practice Address - Street 1:330 IGNACIO BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949
Practice Address - Country:US
Practice Address - Phone:415-883-4631
Practice Address - Fax:415-883-0591
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19799122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist