Provider Demographics
NPI:1699751073
Name:FORBES, LANCE P (DDS)
Entity type:Individual
Prefix:DR
First Name:LANCE
Middle Name:P
Last Name:FORBES
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 COUNCIL ST NE STE D-1
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5893
Mailing Address - Country:US
Mailing Address - Phone:319-390-3703
Mailing Address - Fax:319-390-0525
Practice Address - Street 1:5815 COUNCIL ST NE STE D-1
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5893
Practice Address - Country:US
Practice Address - Phone:319-390-3703
Practice Address - Fax:319-390-0525
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079571223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0176453Medicaid
U73900Medicare UPIN
IA0176453Medicaid