# LANE & ASSOCIATES DDS XVII PA

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

## Provider details

- **NPI number:** 1720131972
- **Authorized official:** ALICIA MARIE DUFFY (CREDENTIALING MANAGER)
- **Authorized official phone:** (919) 295-2757

## Contact information

- **Practice address:** 12450 CLEVELAND RD STE 100, GARNER, NC 27529-8355
- **Practice address phone:** (919) 772-9927
- **Practice address fax:** (919) 772-0647
- **Mailing address:** 12450 CLEVELAND RD, STE 204, GARNER, NC 27529
- **Mailing address phone:** (919) 295-2757
- **Mailing address fax:** (919) 295-2757

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 4785 | NC | Yes |

## Other

- **Enumeration date:** 01/19/2007
- **Last updated:** 02/21/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 017K1 | BCBS-NC HEALTHCHOICE | NC |
| 05 | — | 5902254 | — | NC |