Provider Demographics
NPI:1518092030
Name:LANSDEN, DALE T (DDS)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:T
Last Name:LANSDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 826
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFFS
Mailing Address - State:WY
Mailing Address - Zip Code:82082-0826
Mailing Address - Country:US
Mailing Address - Phone:307-245-3219
Mailing Address - Fax:307-245-3485
Practice Address - Street 1:310 ELM STREET
Practice Address - Street 2:
Practice Address - City:PINE BLUFFS
Practice Address - State:WY
Practice Address - Zip Code:82082-0826
Practice Address - Country:US
Practice Address - Phone:307-245-3219
Practice Address - Fax:307-245-3485
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY8851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice