Provider Demographics
NPI:1518038306
Name:LANCASTER, EDWARD ELI III (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:ELI
Last Name:LANCASTER
Suffix:III
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 1:130 CASCADE TER
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32118-6228
Mailing Address - Country:US
Mailing Address - Phone:321-977-0820
Mailing Address - Fax:
Practice Address - Street 1:1349 S INTERNATIONAL PKWY STE 1441
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-1698
Practice Address - Country:US
Practice Address - Phone:407-833-9533
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC32711223G0001X
FLDN203601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDN20-360OtherFLORIDA DENTAL BOARD
SC3271OtherSOUTH CAROLINA DENTAL BOARD
SC3271OtherSOUTH CAROLINA DENTAL BOARD