Provider Demographics
NPI:1336124197
Name:LANE, EDGAR WINSLOW III (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDGAR
Middle Name:WINSLOW
Last Name:LANE
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:231 13TH AVENUE PL NW
Mailing Address - Street 2:
Mailing Address - City:HICKORY
Mailing Address - State:NC
Mailing Address - Zip Code:28601-2570
Mailing Address - Country:US
Mailing Address - Phone:828-322-6226
Mailing Address - Fax:828-324-1549
Practice Address - Street 1:231 13TH AVENUE PL NW
Practice Address - Street 2:
Practice Address - City:HICKORY
Practice Address - State:NC
Practice Address - Zip Code:28601-2570
Practice Address - Country:US
Practice Address - Phone:828-322-6226
Practice Address - Fax:828-324-1549
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC35751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice