Provider Demographics
NPI:1699005819
Name:LANCASTER DENTAL ASSOCIATES
Entity type:Organization
Organization Name:LANCASTER DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:608-723-2141
Mailing Address - Street 1:237 W HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:WI
Mailing Address - Zip Code:53813-1457
Mailing Address - Country:US
Mailing Address - Phone:608-723-2141
Mailing Address - Fax:608-723-2198
Practice Address - Street 1:237 W HICKORY ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:WI
Practice Address - Zip Code:53813-1457
Practice Address - Country:US
Practice Address - Phone:608-723-2141
Practice Address - Fax:608-723-2198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2250261QD0000X
WI5911261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental