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Organization
LANE & ASSOCIATES DDS XVII PA
Active
Organization
LANE & ASSOCIATES DDS XVII PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA MARIE DUFFY (CREDENTIALING MANAGER)
(919) 295-2757
Entity
Organization
Contact information
Practice address
12450 CLEVELAND RD STE 100, GARNER, NC 27529-8355
(919) 772-9927
(919) 772-0647
Mailing address
12450 CLEVELAND RD, STE 204, GARNER, NC 27529
(919) 295-2757
(919) 295-2757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
017K1
BCBS-NC HEALTHCHOICE
NC
05
—
5902254
—
NC
Enumeration date
01/19/2007
Last updated
02/21/2023
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