Healthcare Provider Details

I. General information

NPI: 1912169616
Provider Name (Legal Business Name): CARTER A LANE DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2008
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

73-899 HIGHWAY 111 SUITE B
PALM DESERT CA
92260
US

IV. Provider business mailing address

P.O. BOX 3
LOMA LINDA CA
92354
US

V. Phone/Fax

Practice location:
  • Phone: 909-799-1825
  • Fax: 714-986-9052
Mailing address:
  • Phone: 714-986-9043
  • Fax: 714-986-9052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number47247
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: