Provider Demographics
NPI:1770599607
Name:LANE, JOHN DENNIS (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DENNIS
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 1:206 TIMBERCREST DR
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-1572
Mailing Address - Country:US
Mailing Address - Phone:847-895-8343
Mailing Address - Fax:847-895-8933
Practice Address - Street 1:724 E NORTHWEST HWY
Practice Address - Street 2:
Practice Address - City:MOUNT PROSPECT
Practice Address - State:IL
Practice Address - Zip Code:60056-3442
Practice Address - Country:US
Practice Address - Phone:847-392-4270
Practice Address - Fax:847-398-8420
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice