MEDICARE: LANE AND ASSOCIATES XLVI DDS PA

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
2	122300000X	Dentist

General Provider Information

NPI Number	:	1831820927
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANE AND ASSOCIATES XLVI DDS PA

Provider Business Mailing Address
First Line	:	2201 CANDUN DR STE 202
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-6413
Country	:	US
Telephone Number	:	919-387-7433
Fax Number	:	919-387-7005

Provider Business Practice Location Address
First Line	:	2201 CANDUN DR STE 202
Second Line	:
City	:	APEX
State	:	NC
Zip	:	27523-6413
Country	:	US
Telephone Number	:	919-387-7433
Fax Number	:	919-387-7005

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MS. ALICIA MARIE DUFFY
Credential	:
Telephone Number	:	919-295-2757

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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