Healthcare Provider Details

I. General information

NPI: 1780044149
Provider Name (Legal Business Name): CHARLES JOHN LALANE DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2016
Last Update Date: 08/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

832 SW 36TH AVE
BOYNTON BEACH FL
33435-8514
US

IV. Provider business mailing address

2521 S FEDERAL HWY
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-685-1142
  • Fax:
Mailing address:
  • Phone: 561-735-3200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN22043
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: