Provider Demographics
NPI:1205857588
Name:LANE, HILARY MARIE-SKUZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:HILARY
Middle Name:MARIE-SKUZA
Last Name:LANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:HOLLAND
Mailing Address - State:MI
Mailing Address - Zip Code:49423-4721
Mailing Address - Country:US
Mailing Address - Phone:616-881-9545
Mailing Address - Fax:
Practice Address - Street 1:540 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:HOLLAND
Practice Address - State:MI
Practice Address - Zip Code:49423-4721
Practice Address - Country:US
Practice Address - Phone:616-881-9545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019061122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist