Provider Demographics
NPI:1083345664
Name:LANE AND ASSOCIATES XLVII DDS PA
Entity Type:Organization
Organization Name:LANE AND ASSOCIATES XLVII DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-295-2757
Mailing Address - Street 1:12450 CLEVELAND RD STE 204
Mailing Address - Street 2:
Mailing Address - City:GARNER
Mailing Address - State:NC
Mailing Address - Zip Code:27529-8355
Mailing Address - Country:US
Mailing Address - Phone:919-295-2757
Mailing Address - Fax:
Practice Address - Street 1:515 S CASWELL ST
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:NC
Practice Address - Zip Code:28551-2005
Practice Address - Country:US
Practice Address - Phone:252-566-9616
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-23
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No122300000XDental ProvidersDentistGroup - Multi-Specialty