Individual
JASON LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4155 DEAN LAKES BLVD, SHAKOPEE, MN 55379-2851
(952) 303-8320
Mailing address
2600 39TH AVE NE, SUITE 225, ST. ANTHONY, MN 55421
(507) 250-4627
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
13362
MN
Other
Enumeration date
04/29/2014
Last updated
07/21/2022
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