Provider Demographics
NPI:1467522474
Name:LANE, EDWARD SIDNEY II (DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:SIDNEY
Last Name:LANE
Suffix:II
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38119-3879
Mailing Address - Country:US
Mailing Address - Phone:901-767-8152
Mailing Address - Fax:
Practice Address - Street 1:5565 MURRAY RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38119-3879
Practice Address - Country:US
Practice Address - Phone:901-767-8152
Practice Address - Fax:901-761-2574
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics