Provider Demographics
NPI:1811158652
Name:LANE, JENNIFER GOOD (DDS, MD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:GOOD
Last Name:LANE
Suffix:
Gender:F
Credentials:DDS, MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4 VANDERBILT PARK DR STE 210
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-1759
Mailing Address - Country:US
Mailing Address - Phone:828-505-1960
Mailing Address - Fax:828-348-4756
Practice Address - Street 1:4 VANDERBILT PARK DR STE 210
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-1759
Practice Address - Country:US
Practice Address - Phone:828-505-1960
Practice Address - Fax:828-348-4756
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2014-02-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC77701223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery