Individual
JASON LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1301 E PALMER WASILLA HWY STE 600, WASILLA, AK 99654-7256
(907) 373-2200
Mailing address
1301 E PALMER WASILLA HWY STE 600, WASILLA, AK 99654-7256
(907) 373-2200
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
100868
AK
Other
Enumeration date
07/02/2015
Last updated
09/14/2020
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