Provider Demographics
NPI:1437549409
Name:LANE FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:LANE FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:856-429-1333
Mailing Address - Street 1:208 N HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2343
Mailing Address - Country:US
Mailing Address - Phone:856-429-1333
Mailing Address - Fax:856-429-8043
Practice Address - Street 1:208 N HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2343
Practice Address - Country:US
Practice Address - Phone:856-429-1333
Practice Address - Fax:856-429-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI011314001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty