Organization
LANE CENTER FOR ADVANCED DENTISTRY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GREGORY EARL LANE D.M.D. (SOLE MEMBER)
(724) 836-4433
Entity
Organization
Contact information
Practice address
4623 STATE ROUTE 136, GREENSBURG, PA 15601-6415
(724) 836-4433
(724) 836-2507
Mailing address
4623 STATE ROUTE 136, GREENSBURG, PA 15601-6415
(724) 836-4433
(724) 836-2507
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DS0272161
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
729519
UNITED CONCORDIA PROVIDER
PA
Enumeration date
04/17/2007
Last updated
08/22/2020
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