Provider Demographics
NPI:1710007984
Name:KANE, LAURIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 FAIRGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7071
Mailing Address - Country:US
Mailing Address - Phone:323-481-0674
Mailing Address - Fax:
Practice Address - Street 1:51 HUNTFIELD DR STE 100
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:DE
Practice Address - Zip Code:19977-2973
Practice Address - Country:US
Practice Address - Phone:302-508-0037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551971223G0001X
DEG1-00114771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice