Provider Demographics
NPI:1659360881
Name:JULES V. LANE, DDS
Entity Type:Organization
Organization Name:JULES V. LANE, DDS
Other - Org Name:AMERICAN DENTAL CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULES
Authorized Official - Middle Name:V
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-822-8700
Mailing Address - Street 1:35 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HICKSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11801-4266
Mailing Address - Country:US
Mailing Address - Phone:516-822-8700
Mailing Address - Fax:516-931-1010
Practice Address - Street 1:8710 GRAND AVE
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4444
Practice Address - Country:US
Practice Address - Phone:718-429-8300
Practice Address - Fax:516-931-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0197351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01773000Medicaid