Organization
LANE AND ASSOCIATES IV
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY MORAN (COMPTROLLER)
(910) 814-2944
Entity
Organization
Contact information
Practice address
315 HIGHWAY 55 WEST, BOX 180, MOUNT OLIVE, NC 28365
(919) 658-9555
(919) 658-1009
Mailing address
315 HIGHWAY 55 WEST, BOX 180, MOUNT OLIVE, NC 28365
(919) 658-9555
(919) 658-1009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0207F
BCBS-NC HEALTHCHOICE
NC
01
—
1378584
UNITED CONCORDIA
NC
05
—
890207F
—
NC
Enumeration date
01/16/2007
Last updated
08/22/2020
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