Healthcare Provider Details

I. General information

NPI: 1750449690
Provider Name (Legal Business Name): LANCE DAVID ASHLOCK DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5336 ESTATE OFFICE DR STE #1
MEMPHIS TN
38119
US

IV. Provider business mailing address

5336 ESTATE OFFICE DR STE #1
MEMPHIS TN
38119
US

V. Phone/Fax

Practice location:
  • Phone: 901-681-0408
  • Fax: 901-681-9753
Mailing address:
  • Phone: 901-681-0408
  • Fax: 901-681-9753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS00007770
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: