Organization
LANE AND ASSOCIATES XXXIX DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA DUFFY (CREDENTIALING MANAGER)
(919) 295-2757
Entity
Organization
Contact information
Practice address
161 KODIAK LN, MOUNT AIRY, NC 27030-5399
(336) 789-1025
(336) 789-1158
Mailing address
161 KODIAK LN, MOUNT AIRY, NC 27030-5399
(336) 789-1025
(336) 789-1158
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
1223G0001X
General Practice Dentistry
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5070979
—
NC
Enumeration date
09/24/2020
Last updated
10/06/2022
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