Provider Demographics
NPI:1235481052
Name:LANCE W. GLEDHILL, DDS, PLLC
Entity Type:Organization
Organization Name:LANCE W. GLEDHILL, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GLEDHILL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-783-8822
Mailing Address - Street 1:7223 W CLEARWATER AVE
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-1758
Mailing Address - Country:US
Mailing Address - Phone:509-783-8822
Mailing Address - Fax:509-783-1983
Practice Address - Street 1:7223 W CLEARWATER AVE
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-1758
Practice Address - Country:US
Practice Address - Phone:509-783-8822
Practice Address - Fax:509-783-1983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000110691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty