# LANE & ASSOCIATES XXI, DDS PA

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

## Provider details

- **NPI number:** 1275819708
- **Authorized official:** PHILLIP BUTTS (VP CONTRACTS AND DEVELOPMENT)
- **Authorized official phone:** (919) 863-9763

## Contact information

- **Practice address:** 4106 WAKE FOREST RD, SUITE 203, RALEIGH, NC 27609-6398
- **Practice address phone:** (919) 277-0577
- **Mailing address:** 4106 WAKE FOREST RD, SUITE 203, RALEIGH, NC 27609-6398
- **Mailing address phone:** (919) 277-0577

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4785 | NC | — |
| 1223P0300X | Periodontics | 4785 | NC | — |
| 1223S0112X | Oral and Maxillofacial Surgery (Dentist) | 4785 | NC | Yes |

## Other

- **Enumeration date:** 10/28/2011
- **Last updated:** 10/28/2011