Provider Demographics
NPI:1942754536
Name:LANE, DONALD (DMD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:
Last Name:LANE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46921 WARM SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94539-7933
Mailing Address - Country:US
Mailing Address - Phone:510-792-7888
Mailing Address - Fax:
Practice Address - Street 1:46921 WARM SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94539-7933
Practice Address - Country:US
Practice Address - Phone:510-792-7888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-11
Last Update Date:2016-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33793122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist