MEDICARE: DR. EDWARD ELI LANCASTER III D.M.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	3271	SC
2	1223G0001X	General Practice Dentistry	DN20360	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DN20-360	OTHER	FL	FLORIDA DENTAL BOARD
2	3271	OTHER	SC	SOUTH CAROLINA DENTAL BOARD

General Provider Information

NPI Number	:	1518038306
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EDWARD ELI LANCASTER III D.M.D

Provider Business Mailing Address
First Line	:	130 CASCADE TER
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32118-6228
Country	:	US
Telephone Number	:	321-977-0820
Fax Number	:

Provider Business Practice Location Address
First Line	:	1349 S INTERNATIONAL PKWY STE 1441
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-1698
Country	:	US
Telephone Number	:	407-833-9533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2006
Last Update Date	:	09/09/2024

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