Provider Demographics
NPI:1497758320
Name:STUMPOS, LANE C (DDS)
Entity Type:Individual
Prefix:DR
First Name:LANE
Middle Name:C
Last Name:STUMPOS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:ALBION
Mailing Address - State:MI
Mailing Address - Zip Code:49224-1793
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:49224-1793
Practice Address - Country:US
Practice Address - Phone:517-629-9107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0141491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4252641Medicaid