Provider Demographics
NPI:1225613813
Name:LANE FAMILY DENTAL, LLC
Entity Type:Organization
Organization Name:LANE FAMILY DENTAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:907-373-2200
Mailing Address - Street 1:1301 E PALMER WASILLA HWY STE 600
Mailing Address - Street 2:
Mailing Address - City:WASILLA
Mailing Address - State:AK
Mailing Address - Zip Code:99654-7256
Mailing Address - Country:US
Mailing Address - Phone:907-373-2200
Mailing Address - Fax:
Practice Address - Street 1:1301 E PALMER WASILLA HWY STE 600
Practice Address - Street 2:
Practice Address - City:WASILLA
Practice Address - State:AK
Practice Address - Zip Code:99654-7256
Practice Address - Country:US
Practice Address - Phone:907-373-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-15
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty