Organization
LANE & ASSOCIATES X DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA MARIE DUFFY (CREDENTIALING MANAGER)
(919) 295-2757
Entity
Organization
Contact information
Practice address
407 TIFFANY DR, SANFORD, NC 27330-9306
(919) 774-6311
(919) 775-4115
Mailing address
407 TIFFANY DR, SANFORD, NC 27330
(919) 774-6311
(919) 775-4115
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
015PY
BCBS-NC HEALTHCHOICE
NC
01
—
1593877
UNITED CONCORDIA
NC
05
—
89015PY
—
NC
Enumeration date
01/22/2007
Last updated
03/08/2023
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