Provider Demographics
NPI:1447601273
Name:LANE, DAVID (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:LANE
Suffix:
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 1:95 OLD DIXIE HWY STE A
Mailing Address - Street 2:
Mailing Address - City:ADAIRSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30103-2044
Mailing Address - Country:US
Mailing Address - Phone:888-411-2290
Mailing Address - Fax:650-412-9650
Practice Address - Street 1:95 OLD DIXIE HWY STE A
Practice Address - Street 2:
Practice Address - City:ADAIRSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30103-2044
Practice Address - Country:US
Practice Address - Phone:888-411-2290
Practice Address - Fax:650-412-9650
Is Sole Proprietor?:No
Enumeration Date:2016-06-22
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN015209122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist