Provider Demographics
NPI:1891146759
Name:VANGUILDER, LANCETTE
Entity Type:Individual
Prefix:
First Name:LANCETTE
Middle Name:
Last Name:VANGUILDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 ROUNDSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89436-1606
Mailing Address - Country:US
Mailing Address - Phone:775-224-4323
Mailing Address - Fax:
Practice Address - Street 1:4331 ROUNDSTONE DR
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89436-1606
Practice Address - Country:US
Practice Address - Phone:775-224-4323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-22
Last Update Date:2016-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV3227124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist