Individual
ANDREW CHARLES LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3181 SW SAM JACKSON PARK RD, PORTLAND, OR 97239-3098
(503) 494-8211
Mailing address
841 S GAINES ST UNIT 311, PORTLAND, OR 97239-3133
(636) 328-3993
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D11061
OR
122300000X
Dentist
DE61077121
WA
1223P0221X
Pediatric Dentistry
Primary
D11061
OR
Other
Enumeration date
04/01/2019
Last updated
02/06/2024
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