Provider Demographics
NPI:1881600971
Name:PRICE, ROBERT LANE (DDS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LANE
Last Name:PRICE
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 1:2046 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5306
Mailing Address - Country:US
Mailing Address - Phone:318-798-0868
Mailing Address - Fax:318-798-0842
Practice Address - Street 1:2046 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5306
Practice Address - Country:US
Practice Address - Phone:318-798-0868
Practice Address - Fax:318-798-0842
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
LA42171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice