Provider Demographics
NPI:1841280906
Name:LANE, DANIEL JAY (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:JAY
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 1:7307 BALTIMORE AVE
Mailing Address - Street 2:STE 113
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-3231
Mailing Address - Country:US
Mailing Address - Phone:301-927-9011
Mailing Address - Fax:301-927-8944
Practice Address - Street 1:7307 BALTIMORE AVE
Practice Address - Street 2:STE 113
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3231
Practice Address - Country:US
Practice Address - Phone:301-927-9011
Practice Address - Fax:301-927-8944
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD5779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist