Provider Demographics
NPI:1295926137
Name:LANE, RONALD PAUL (DDS)
Entity type:Individual
Prefix:
First Name:RONALD
Middle Name:PAUL
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:PO BOX 810
Mailing Address - Street 2:
Mailing Address - City:ORTONVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48462-0810
Mailing Address - Country:US
Mailing Address - Phone:248-627-2866
Mailing Address - Fax:248-627-9954
Practice Address - Street 1:1201 S ORTONVILLE RD
Practice Address - Street 2:
Practice Address - City:ORTONVILLE
Practice Address - State:MI
Practice Address - Zip Code:48462-8547
Practice Address - Country:US
Practice Address - Phone:248-627-2866
Practice Address - Fax:248-627-9954
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-06
Last Update Date:2007-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI137721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice