Individual
BRETT JACK LANCASTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D
Contact information
Practice address
1361 E 16TH ST, #2, BURLEY, ID 83318-2008
(208) 677-5198
(208) 678-2245
Mailing address
794 EASTLAND DR, TWIN FALLS, ID 83301-6856
(208) 734-3312
(208) 734-5036
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-4412
ID
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
05/31/2010
Last updated
12/10/2012
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