Provider Demographics
NPI:1629122528
Name:LANE AND ASSOCIATES XIV DDS PA
Entity Type:Organization
Organization Name:LANE AND ASSOCIATES XIV DDS PA
Other - Org Name:DURHAM FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-295-2757
Mailing Address - Street 1:1200 BROAD ST STE 300
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27705-3573
Mailing Address - Country:US
Mailing Address - Phone:919-286-6646
Mailing Address - Fax:919-286-6668
Practice Address - Street 1:1200 BROAD ST STE 300
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27705-3573
Practice Address - Country:US
Practice Address - Phone:919-286-6646
Practice Address - Fax:919-286-6668
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2023-04-04
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
NC89016TGMedicaid
NC016YUOtherBCBS-NC HEALTHCHOICE
NC89016TGMedicaid