Provider Demographics
NPI:1265463673
Name:LACEY, WILLIAM EARL JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:EARL
Last Name:LACEY
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 W 2ND AVENUE
Mailing Address - Street 2:STE A
Mailing Address - City:DURANGO
Mailing Address - State:CO
Mailing Address - Zip Code:81301
Mailing Address - Country:US
Mailing Address - Phone:970-375-7671
Mailing Address - Fax:970-375-1239
Practice Address - Street 1:2323 W 2ND AVENUE
Practice Address - Street 2:STE A
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301
Practice Address - Country:US
Practice Address - Phone:970-375-7671
Practice Address - Fax:970-375-1239
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO8056122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist