Healthcare Provider Details

I. General information

NPI: 1245992999
Provider Name (Legal Business Name): LANE AND ASSOCIATES XLII DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2021
Last Update Date: 04/28/2022
Certification Date: 04/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 CAPITAL BLVD
RALEIGH NC
27604-2236
US

IV. Provider business mailing address

2401 CAPITAL BLVD
RALEIGH NC
27604-2236
US

V. Phone/Fax

Practice location:
  • Phone: 919-827-8980
  • Fax: 919-827-8981
Mailing address:
  • Phone: 877-526-3337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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