# LANE AND ASSOCIATES XII DDS PA

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Lane and Associates XII
- **Organization subpart:** No

## Provider details

- **NPI number:** 1811041700
- **Authorized official:** ALICIA DUFFY (CREDENTIALING MANAGER)
- **Authorized official phone:** (919) 295-2757

## Contact information

- **Practice address:** 4106 WAKE FOREST RD STE 100, RALEIGH, NC 27609-6397
- **Practice address phone:** (919) 876-2464
- **Practice address fax:** (919) 876-1409
- **Mailing address:** 4106 WAKE FOREST RD, SUITE 100, RALEIGH, NC 27609-6227
- **Mailing address phone:** (919) 876-2464
- **Mailing address fax:** (919) 876-1409

## Taxonomy

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

## Other

- **Enumeration date:** 01/22/2007
- **Last updated:** 11/27/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 016YF | BCBS-NC HEALTHCHOICE | NC |
| 05 | — | 89016TJ | — | NC |