Provider Demographics
NPI:1932206000
Name:LANE, LINDA G
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:G
Last Name:LANE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 LEE AVE
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-9423
Mailing Address - Country:US
Mailing Address - Phone:979-233-8573
Mailing Address - Fax:979-297-6226
Practice Address - Street 1:102 FLAG LAKE DR STE C
Practice Address - Street 2:
Practice Address - City:LAKE JACKSON
Practice Address - State:TX
Practice Address - Zip Code:77566-6215
Practice Address - Country:US
Practice Address - Phone:979-297-1201
Practice Address - Fax:979-297-6226
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant