Provider Demographics
NPI:1508098971
Name:CHRISTOPHER J LANE DDS, PLLC
Entity Type:Organization
Organization Name:CHRISTOPHER J LANE DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:BS, DDS
Authorized Official - Phone:914-946-1249
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0421921223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01455985Medicaid
NYD5M421OtherMEDICARE ID TYPE UNSPECIFIED
NYU57582Medicare UPIN