Provider Demographics
NPI:1326233412
Name:MOUNTAIN DENTAL CARE, PLLC
Entity Type:Organization
Organization Name:MOUNTAIN DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:276-870-8081
Mailing Address - Street 1:PO BOX 339
Mailing Address - Street 2:
Mailing Address - City:MIDDLESBORO
Mailing Address - State:KY
Mailing Address - Zip Code:40965-0339
Mailing Address - Country:US
Mailing Address - Phone:276-870-8081
Mailing Address - Fax:
Practice Address - Street 1:2004 CUMBERLAND AVENUE
Practice Address - Street 2:APEX MEDICAL BUILDING SUITE333
Practice Address - City:MIDDLESBORO
Practice Address - State:KY
Practice Address - Zip Code:40965
Practice Address - Country:US
Practice Address - Phone:276-870-8081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-11
Last Update Date:2007-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7599122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty