# ANDREW CHARLES LANE

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1891257747
- **Gender:** Man
- **Credential:** DMD

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | D11061 | OR | — |
| 122300000X | Dentist | DE61077121 | WA | — |
| 1223P0221X | Pediatric Dentistry | D11061 | OR | Yes |

## Other

- **Enumeration date:** 04/01/2019
- **Last updated:** 02/06/2024