Provider Demographics
NPI:1154496610
Name:MCLANE, EMMETT R (DDS)
Entity Type:Individual
Prefix:DR
First Name:EMMETT
Middle Name:R
Last Name:MCLANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 LONGWOOD AVE # A
Mailing Address - Street 2:P O BOX 909
Mailing Address - City:FARMVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23901-1524
Mailing Address - Country:US
Mailing Address - Phone:434-392-5377
Mailing Address - Fax:434-392-1541
Practice Address - Street 1:400 LONGWOOD AVE # A
Practice Address - Street 2:
Practice Address - City:FARMVILLE
Practice Address - State:VA
Practice Address - Zip Code:23901-1524
Practice Address - Country:US
Practice Address - Phone:434-392-5377
Practice Address - Fax:434-392-1541
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010056171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice