Provider Demographics
NPI:1306006986
Name:LANE, ROBERT PERSON (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:PERSON
Last Name:LANE
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 1:4561 MILLBRANCH RD STE 1
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38116-7437
Mailing Address - Country:US
Mailing Address - Phone:901-396-5700
Mailing Address - Fax:347-442-3138
Practice Address - Street 1:4561 MILLBRANCH RD STE 1
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38116-7437
Practice Address - Country:US
Practice Address - Phone:901-396-5700
Practice Address - Fax:347-442-3138
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-17
Last Update Date:2018-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0471641223G0001X
TN0085511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1306006986Medicaid