Provider Demographics
NPI:1619372703
Name:LINDSAY A. BANCROFT, D.D.S., INC.
Entity type:Organization
Organization Name:LINDSAY A. BANCROFT, D.D.S., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BANCROFT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:716-432-9554
Mailing Address - Street 1:12750 CARMEL COUNTRY RD STE 206
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2171
Mailing Address - Country:US
Mailing Address - Phone:858-755-3780
Mailing Address - Fax:
Practice Address - Street 1:12750 CARMEL COUNTRY RD STE 206
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2171
Practice Address - Country:US
Practice Address - Phone:858-755-3780
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60840122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty