Provider Demographics
NPI:1013133206
Name:LANE CENTER FOR ADVANCED DENTISTRY, LLC
Entity Type:Organization
Organization Name:LANE CENTER FOR ADVANCED DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-836-4433
Mailing Address - Street 1:4623 STATE ROUTE 136
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-6415
Mailing Address - Country:US
Mailing Address - Phone:724-836-4433
Mailing Address - Fax:724-836-2507
Practice Address - Street 1:4623 STATE ROUTE 136
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-6415
Practice Address - Country:US
Practice Address - Phone:724-836-4433
Practice Address - Fax:724-836-2507
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS02721611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA729519OtherUNITED CONCORDIA PROVIDER