Provider Demographics
NPI:1508917592
Name:LANE AND ASSOCIATES III, DDS PA
Entity Type:Organization
Organization Name:LANE AND ASSOCIATES III, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-814-2944
Mailing Address - Street 1:15 RAWLS ROAD
Mailing Address - Street 2:SUITE 200 BOX 160
Mailing Address - City:ANGIER
Mailing Address - State:NC
Mailing Address - Zip Code:27501
Mailing Address - Country:US
Mailing Address - Phone:919-639-2272
Mailing Address - Fax:919-639-8654
Practice Address - Street 1:15 RAWLS ROAD
Practice Address - Street 2:SUITE 200 BOX 160
Practice Address - City:ANGIER
Practice Address - State:NC
Practice Address - Zip Code:27501
Practice Address - Country:US
Practice Address - Phone:919-639-2272
Practice Address - Fax:919-639-8654
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0172COtherBCBS-NC HEALTHCHOICE
NC890172CMedicaid
NC138012OtherUNITED CONCORDIA