Provider Demographics
NPI:1871695023
Name:LANCASTER COUNTY DENTAL CLINIC
Entity type:Organization
Organization Name:LANCASTER COUNTY DENTAL CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH DEPT DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:804-758-2381
Mailing Address - Street 1:9049 MARY BALL ROAD
Mailing Address - Street 2:P O BOX 158
Mailing Address - City:LANCASTER
Mailing Address - State:VA
Mailing Address - Zip Code:22503
Mailing Address - Country:US
Mailing Address - Phone:804-758-2381
Mailing Address - Fax:804-758-4828
Practice Address - Street 1:9049 MARY BALL ROAD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:VA
Practice Address - Zip Code:22503
Practice Address - Country:US
Practice Address - Phone:804-758-2381
Practice Address - Fax:804-758-4828
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THREE RIVERS HEALTH DISTRICT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-01
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA041004548251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA106882OtherDORAL (VA. SMILES)
VA845009Medicaid