Provider Demographics
NPI:1841694254
Name:LANE AND ASSOCIATES XXVIII, DDS PA
Entity type:Organization
Organization Name:LANE AND ASSOCIATES XXVIII, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DUFFY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-295-2757
Mailing Address - Street 1:806 W HAMLET AVENUE
Mailing Address - Street 2:
Mailing Address - City:HAMLET
Mailing Address - State:NC
Mailing Address - Zip Code:28435-2508
Mailing Address - Country:US
Mailing Address - Phone:910-582-5143
Mailing Address - Fax:910-582-8620
Practice Address - Street 1:806 W HAMLET AVE STE A
Practice Address - Street 2:
Practice Address - City:HAMLET
Practice Address - State:NC
Practice Address - Zip Code:28345-2508
Practice Address - Country:US
Practice Address - Phone:910-582-5143
Practice Address - Fax:910-582-8620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-14
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty