Organization
LANE & ASSOCIATES XXI, DDS PA
Active
Organization
LANE & ASSOCIATES XXI, DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PHILLIP BUTTS (VP CONTRACTS AND DEVELOPMENT)
(919) 863-9763
Entity
Organization
Contact information
Practice address
4106 WAKE FOREST RD, SUITE 203, RALEIGH, NC 27609-6398
(919) 277-0577
Mailing address
4106 WAKE FOREST RD, SUITE 203, RALEIGH, NC 27609-6398
(919) 277-0577
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
4785
NC
1223P0300X
Periodontics
4785
NC
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
4785
NC
Other
Enumeration date
10/28/2011
Last updated
10/28/2011
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