Provider Demographics
NPI:1942420179
Name:GANE & KARSHNER DDS PA
Entity Type:Organization
Organization Name:GANE & KARSHNER DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LACEY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GANE
Authorized Official - Suffix:II
Authorized Official - Credentials:DDS
Authorized Official - Phone:910-738-2473
Mailing Address - Street 1:4309 LUDGATE ST
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-2460
Mailing Address - Country:US
Mailing Address - Phone:910-738-2473
Mailing Address - Fax:
Practice Address - Street 1:4309 LUDGATE ST
Practice Address - Street 2:
Practice Address - City:LUMBERTON
Practice Address - State:NC
Practice Address - Zip Code:28358-2460
Practice Address - Country:US
Practice Address - Phone:910-738-2473
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-30
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4712122300000X
NC6995122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899009KMedicaid
NC8993076NCMedicaid
NC5921095Medicaid
U38334Medicare UPIN
NC899009KMedicaid