Provider Demographics
NPI:1881171726
Name:CHAD J LANCASTER, DDS, PLLC
Entity type:Organization
Organization Name:CHAD J LANCASTER, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:LANCASTER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:304-364-8565
Mailing Address - Street 1:PO BOX 307
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-0307
Mailing Address - Country:US
Mailing Address - Phone:304-364-8565
Mailing Address - Fax:
Practice Address - Street 1:715 ELK ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1113
Practice Address - Country:US
Practice Address - Phone:304-364-8565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental