Healthcare Provider Details

I. General information

NPI: 1831820927
Provider Name (Legal Business Name): LANE AND ASSOCIATES XLVI DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2022
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 CANDUN DR STE 202
APEX NC
27523-6413
US

IV. Provider business mailing address

2201 CANDUN DR STE 202
APEX NC
27523-6413
US

V. Phone/Fax

Practice location:
  • Phone: 919-387-7433
  • Fax: 919-387-7005
Mailing address:
  • Phone: 919-387-7433
  • Fax: 919-387-7005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. ALICIA MARIE DUFFY
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 919-295-2757