Provider Demographics
NPI:1205802345
Name:LANE, CHRISTOPHER JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:JOSEPH
Last Name:LANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 CHURCH ST
Mailing Address - Street 2:SUITE 404
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-1515
Mailing Address - Country:US
Mailing Address - Phone:914-946-1249
Mailing Address - Fax:
Practice Address - Street 1:95 CHURCH ST
Practice Address - Street 2:SUITE 404
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-1515
Practice Address - Country:US
Practice Address - Phone:914-946-1249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0421921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01455985Medicaid
NYD5M421Medicare ID - Type UnspecifiedMEDICAR AND GHI
NY01455985Medicaid