Healthcare Provider Details

I. General information

NPI: 1811158652
Provider Name (Legal Business Name): JENNIFER GOOD LANE DDS, MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2008
Last Update Date: 02/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 VANDERBILT PARK DR STE 210
ASHEVILLE NC
28803-1759
US

IV. Provider business mailing address

4 VANDERBILT PARK DR STE 210
ASHEVILLE NC
28803-1759
US

V. Phone/Fax

Practice location:
  • Phone: 828-505-1960
  • Fax: 828-348-4756
Mailing address:
  • Phone: 828-505-1960
  • Fax: 828-348-4756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7770
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: