MEDICARE: JOHN D LANE, DDS, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry		IL

General Provider Information

NPI Number	:	1013022821
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHN D LANE, DDS, LTD

Provider Business Mailing Address
First Line	:	724 E NORTHWEST HWY
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3442
Country	:	US
Telephone Number	:	847-392-4270
Fax Number	:	847-398-8420

Provider Business Practice Location Address
First Line	:	724 E NORTHWEST HWY
Second Line	:
City	:	MT PROSPECT
State	:	IL
Zip	:	60056-3442
Country	:	US
Telephone Number	:	847-392-4270
Fax Number	:	847-398-8420

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN DENNIS LANE
Credential	:	DDS
Telephone Number	:	847-392-4270

Provider Enumeration Date	:	08/20/2006
Last Update Date	:	08/22/2020

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