Provider Demographics
NPI:1649233990
Name:LANE, JAMES WARD (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WARD
Last Name:LANE
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:PO BOX 521
Mailing Address - Street 2:208 MAIN STREET
Mailing Address - City:CORNELL
Mailing Address - State:WI
Mailing Address - Zip Code:54732
Mailing Address - Country:US
Mailing Address - Phone:715-239-3166
Mailing Address - Fax:715-239-0346
Practice Address - Street 1:208 MAIN STREET
Practice Address - Street 2:
Practice Address - City:CORNELL
Practice Address - State:WI
Practice Address - Zip Code:54732
Practice Address - Country:US
Practice Address - Phone:715-239-3166
Practice Address - Fax:715-239-0346
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5002082G122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist