Healthcare Provider Details

I. General information

NPI: 1841280906
Provider Name (Legal Business Name): DANIEL JAY LANE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7307 BALTIMORE AVE STE 113
COLLEGE PARK MD
20740-3231
US

IV. Provider business mailing address

7307 BALTIMORE AVE STE 113
COLLEGE PARK MD
20740-3231
US

V. Phone/Fax

Practice location:
  • Phone: 301-927-9011
  • Fax: 301-927-8944
Mailing address:
  • Phone: 301-927-9011
  • Fax: 301-927-8944

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5779
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: