Provider Demographics
NPI:1154684447
Name:LANCASTER DENTAL
Entity Type:Organization
Organization Name:LANCASTER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:D.M.D
Authorized Official - Prefix:
Authorized Official - First Name:MADHURI
Authorized Official - Middle Name:
Authorized Official - Last Name:KAVI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-365-9497
Mailing Address - Street 1:136 HIGH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MA
Mailing Address - Zip Code:01523-2056
Mailing Address - Country:US
Mailing Address - Phone:978-365-9497
Mailing Address - Fax:
Practice Address - Street 1:136 HIGH STREET EXT
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:MA
Practice Address - Zip Code:01523-2056
Practice Address - Country:US
Practice Address - Phone:978-365-9497
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANCASTER DENTAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-21
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN 190901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty