Provider Demographics
NPI:1043427925
Name:BANWELL, LANCE ERIC (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANCE
Middle Name:ERIC
Last Name:BANWELL
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 1:387 MAIN ST S
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06798-3412
Mailing Address - Country:US
Mailing Address - Phone:203-263-5300
Mailing Address - Fax:203-263-4327
Practice Address - Street 1:387 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3412
Practice Address - Country:US
Practice Address - Phone:203-263-5300
Practice Address - Fax:203-263-4327
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT05392122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist