Provider Demographics
NPI:1396834594
Name:LANE, ROBERT JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:LANE
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:83 HIGH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-2190
Mailing Address - Country:US
Mailing Address - Phone:301-885-2728
Mailing Address - Fax:
Practice Address - Street 1:83 HIGH ST
Practice Address - Street 2:SUITE B
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2190
Practice Address - Country:US
Practice Address - Phone:301-885-2728
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD122781223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice