# LANE AND ASSOCIATES LIII DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073341608
- **Authorized official:** ALICIA DUFFY (CREDENTIALING MANAGER)
- **Authorized official phone:** (919) 295-2757

## Contact information

- **Practice address:** 1890 BROAD ST, FUQUAY VARINA, NC 27526
- **Practice address phone:** (919) 295-2757
- **Mailing address:** 1890 BROAD ST, FUQUAY VARINA, NC 27526
- **Mailing address phone:** (919) 295-2757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |
| 1223P0300X | Periodontics | — | NULL | — |
| 1223P0300X | Periodontics | — | — | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | NULL | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | — | — | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | NULL | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | — | — | — |

## Other

- **Enumeration date:** 07/24/2024
- **Last updated:** 07/24/2024