Provider Demographics
NPI:1114130200
Name:LANCASTER, JEFF
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 WREN RD
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-2312
Mailing Address - Country:US
Mailing Address - Phone:615-859-2757
Mailing Address - Fax:615-851-8474
Practice Address - Street 1:818 WREN RD
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-2312
Practice Address - Country:US
Practice Address - Phone:615-859-2757
Practice Address - Fax:615-851-8474
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNTN 72521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice