MEDICARE: LANE AND ASSOCIATES XXIX, DDS, PA

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	1223E0200X	Endodontics
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)
3	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry
4	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1851746853
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANE AND ASSOCIATES XXIX, DDS, PA

Provider Business Mailing Address
First Line	:	6480 TRYON RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-7050
Country	:	US
Telephone Number	:	919-639-0264
Fax Number	:	919-331-2415

Provider Business Practice Location Address
First Line	:	6480 TRYON RD
Second Line	:
City	:	CARY
State	:	NC
Zip	:	27518-7050
Country	:	US
Telephone Number	:	919-639-0264
Fax Number	:	919-331-2415

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	MRS. ERIN S POPE
Credential	:
Telephone Number	:	919-639-0264

Provider Enumeration Date	:	04/27/2016
Last Update Date	:	04/27/2016

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