Organization
LANE & ASSOCIATES XXII, 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 201, RALEIGH, NC 27609-6398
(919) 277-0788
Mailing address
4106 WAKE FOREST RD, SUITE 201, RALEIGH, NC 27609-6398
(919) 277-0788
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
4785
NC
Other
Enumeration date
11/01/2011
Last updated
11/01/2011
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