Provider Demographics
NPI:1861815698
Name:LANE AND ASSOCIATES XXIII, DDS, PA
Entity Type:Organization
Organization Name:LANE AND ASSOCIATES XXIII, 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 1:796 EAST STREET
Mailing Address - Street 2:
Mailing Address - City:PITTSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27312-8815
Mailing Address - Country:US
Mailing Address - Phone:919-704-8084
Mailing Address - Fax:919-704-8089
Practice Address - Street 1:796 EAST ST
Practice Address - Street 2:
Practice Address - City:PITTSBORO
Practice Address - State:NC
Practice Address - Zip Code:27312-8815
Practice Address - Country:US
Practice Address - Phone:919-704-8084
Practice Address - Fax:919-704-8089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty