Organization
LANE AND ASSOCIATES XII DDS PA
Active
Other names
Lane and Associates XII
Organization subpart
No
Provider details
NPI number
Authorized official
ALICIA DUFFY (CREDENTIALING MANAGER)
(919) 295-2757
Entity
Organization
Contact information
Practice address
4106 WAKE FOREST RD STE 100, RALEIGH, NC 27609-6397
(919) 876-2464
(919) 876-1409
Mailing address
4106 WAKE FOREST RD, SUITE 100, RALEIGH, NC 27609-6227
(919) 876-2464
(919) 876-1409
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
4785
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
016YF
BCBS-NC HEALTHCHOICE
NC
05
—
89016TJ
—
NC
Enumeration date
01/22/2007
Last updated
11/27/2023
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