Organization
LANE AND ASSOCIATES LIII DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA DUFFY (CREDENTIALING MANAGER)
(919) 295-2757
Entity
Organization
Contact information
Practice address
1890 BROAD ST, FUQUAY VARINA, NC 27526
(919) 295-2757
Mailing address
1890 BROAD ST, FUQUAY VARINA, NC 27526
(919) 295-2757
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
1223P0300X
Periodontics
—
—
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
—
—
Other
Enumeration date
07/24/2024
Last updated
07/24/2024
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