Provider Demographics
NPI:1053438978
Name:WILLIAM S LANCASTER, DDS HERBERT J EMMONS, DDS GARY J SURMAN, DDS D
Entity type:Organization
Organization Name:WILLIAM S LANCASTER, DDS HERBERT J EMMONS, DDS GARY J SURMAN, DDS D
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OF PROF. CORP.
Authorized Official - Prefix:DR
Authorized Official - First Name:HERBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:EMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:518-827-5171
Mailing Address - Street 1:PO BOX 351
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12122-0351
Mailing Address - Country:US
Mailing Address - Phone:518-827-5171
Mailing Address - Fax:
Practice Address - Street 1:106 DIVISION ST
Practice Address - Street 2:
Practice Address - City:COBLESKILL
Practice Address - State:NY
Practice Address - Zip Code:12043-4605
Practice Address - Country:US
Practice Address - Phone:518-827-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0297121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty