Individual
NICOLE VICTORIA LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
3702 2ND AVE, COLUMBUS, GA 31904-7408
(706) 507-9209
Mailing address
3702 2ND AVE, COLUMBUS, GA 31904-7408
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN122655
GA
Other
Enumeration date
06/02/2022
Last updated
06/02/2022
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