Provider Demographics
NPI:1215142617
Name:DENTAL ASSOCIATES OF LANCASTER INC
Entity type:Organization
Organization Name:DENTAL ASSOCIATES OF LANCASTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-654-3660
Mailing Address - Street 1:PO BOX 721
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-0721
Mailing Address - Country:US
Mailing Address - Phone:740-654-3660
Mailing Address - Fax:740-654-3643
Practice Address - Street 1:115 W FAIR AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1804
Practice Address - Country:US
Practice Address - Phone:740-654-3660
Practice Address - Fax:740-654-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH206941223G0001X
OH176401223G0001X
OH141021223G0001X
OH218931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========OtherTAX IDENTIFICATION NUMBER