Healthcare Provider Details

I. General information

NPI: 1962911743
Provider Name (Legal Business Name): LANCER.WASHBURN DDS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 09/25/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 N NEW WARRINGTON RD
PENSACOLA FL
32506-4244
US

IV. Provider business mailing address

627 N NEW WARRINGTON RD
PENSACOLA FL
32506-4244
US

V. Phone/Fax

Practice location:
  • Phone: 850-453-3245
  • Fax:
Mailing address:
  • Phone: 850-453-3245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. LANCE RAWSON WASHBURN
Title or Position: DOCTOR
Credential:
Phone: 850-453-3245