Provider Demographics
NPI:1447609714
Name:LANE, ALLISON
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 CHESTER BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1919
Mailing Address - Country:US
Mailing Address - Phone:765-966-3736
Mailing Address - Fax:
Practice Address - Street 1:1429 CHESTER BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1919
Practice Address - Country:US
Practice Address - Phone:765-966-3736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012515A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist