Provider Demographics
NPI:1336678440
Name:LANCASTER, ROBERT KENNETH (DMD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:KENNETH
Last Name:LANCASTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 PROFESSIONAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:GA
Mailing Address - Zip Code:31525-6743
Mailing Address - Country:US
Mailing Address - Phone:912-264-5550
Mailing Address - Fax:
Practice Address - Street 1:110 PROFESSIONAL CENTER DR
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:GA
Practice Address - Zip Code:31525-6743
Practice Address - Country:US
Practice Address - Phone:912-264-5550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-12
Last Update Date:2024-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADNO153861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice