Provider Demographics
NPI:1629327507
Name:H. LANCE DONALD DDS
Entity Type:Organization
Organization Name:H. LANCE DONALD DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:LANCE
Authorized Official - Last Name:DONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:318-324-0080
Mailing Address - Street 1:106 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5332
Mailing Address - Country:US
Mailing Address - Phone:318-324-0080
Mailing Address - Fax:318-324-0087
Practice Address - Street 1:106 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291-5332
Practice Address - Country:US
Practice Address - Phone:318-324-0080
Practice Address - Fax:318-324-0087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-06
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA47771223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1847763Medicaid