Provider Demographics
NPI:1437531928
Name:LANE C. STUMPOS DDS PC
Entity Type:Organization
Organization Name:LANE C. STUMPOS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LANE
Authorized Official - Middle Name:
Authorized Official - Last Name:STUMPOS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-629-9107
Mailing Address - Street 1:301 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1739
Mailing Address - Country:US
Mailing Address - Phone:517-629-9107
Mailing Address - Fax:
Practice Address - Street 1:301 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:ALBION
Practice Address - State:MI
Practice Address - Zip Code:49224-1739
Practice Address - Country:US
Practice Address - Phone:517-629-9107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI014149122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty