Healthcare Provider Details

I. General information

NPI: 1881837300
Provider Name (Legal Business Name): LANE & ASSOCIATES XIX DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2009
Last Update Date: 07/24/2024
Certification Date: 07/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2613 GREEN LEVEL WEST RD
CARY NC
27519-8284
US

IV. Provider business mailing address

2613 GREEN LEVEL WEST RD
CARY NC
27519-8284
US

V. Phone/Fax

Practice location:
  • Phone: 919-589-0270
  • Fax: 919-589-0275
Mailing address:
  • Phone: 919-589-0270
  • Fax: 919-589-0275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

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