Healthcare Provider Details

I. General information

NPI: 1396187746
Provider Name (Legal Business Name): PATRICE LANE DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2013
Last Update Date: 04/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7212 REGIONAL ST
DUBLIN CA
94568
US

IV. Provider business mailing address

651 W WATERMAN DR
MOUNTAIN HOUSE CA
95391-1439
US

V. Phone/Fax

Practice location:
  • Phone: 925-201-6011
  • Fax:
Mailing address:
  • Phone: 254-135-9819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number62660
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: