Provider Demographics
NPI:1710031612
Name:LANE & ASSOCIATES XIII DDS PA
Entity Type:Organization
Organization Name:LANE & ASSOCIATES XIII DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ERIN
Authorized Official - Middle Name:SNIPES
Authorized Official - Last Name:POPE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-639-0264
Mailing Address - Street 1:5923 W FRIENDLY AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-3207
Mailing Address - Country:US
Mailing Address - Phone:336-632-0744
Mailing Address - Fax:336-632-0754
Practice Address - Street 1:5923 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-3207
Practice Address - Country:US
Practice Address - Phone:336-632-0744
Practice Address - Fax:336-632-0754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2018-06-21
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
NC89016THMedicaid
NC016YAOtherBCBS-NC HEALTHCHOICE
NC016YAOtherBCBS-NC HEALTHCHOICE