Healthcare Provider Details

I. General information

NPI: 1912839994
Provider Name (Legal Business Name): LANSFORD DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 VINE ST
PASO ROBLES CA
93446-2561
US

IV. Provider business mailing address

1134 VINE ST
PASO ROBLES CA
93446-2561
US

V. Phone/Fax

Practice location:
  • Phone: 805-238-1441
  • Fax: 805-238-3836
Mailing address:
  • Phone: 805-238-1441
  • Fax: 805-238-3836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: JEREMY S LANSFORD
Title or Position: OWNER
Credential: DDS
Phone: 805-238-1441