Individual
DR. KATHERINE JEAN LANE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.M.D, M.S.D
Contact information
Practice address
5135 SKYLINE RD S, SALEM, OR 97306-9427
(541) 880-2090
(541) 880-2092
Mailing address
5111 ZOSEL AVE S, SALEM, OR 97306-2103
(503) 866-0920
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
D8774
OR
1223P0221X
Pediatric Dentistry
Primary
D8774
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
D8774
OREGON DENTIST LICENSE
OR
Enumeration date
01/04/2007
Last updated
06/26/2014
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