Individual
LANE MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1061 S STATE ROUTE 260, COTTONWOOD, AZ 86326-4624
(928) 472-8000
Mailing address
1061 S STATE ROUTE 260, COTTONWOOD, AZ 86326-4624
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D009043
AZ
Other
Enumeration date
09/24/2014
Last updated
09/24/2014
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