Provider Demographics
NPI:1518038306
Name:LANCASTER, EDWARD ELI III (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ELI
Last Name:LANCASTER
Suffix:III
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 1:505 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32951-2123
Mailing Address - Country:US
Mailing Address - Phone:786-468-9266
Mailing Address - Fax:
Practice Address - Street 1:505 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32951-2123
Practice Address - Country:US
Practice Address - Phone:786-468-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN20-360OtherFLORIDA DENTAL BOARD
NC6768OtherNORTH CAROLINA DENTAL BOARD
SC3271OtherSOUTH CAROLINA DENTAL BOARD