Healthcare Provider Details

I. General information

NPI: 1881940906
Provider Name (Legal Business Name): LANE AND ASSOCIATES XXVI DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 05/04/2022
Certification Date: 05/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E DR MARTIN L KING JR BLVD
ROSEBORO NC
28382-9063
US

IV. Provider business mailing address

401 E NC HIGHWAY 24
ROSEBORO NC
28382-8736
US

V. Phone/Fax

Practice location:
  • Phone: 910-525-5115
  • Fax: 910-525-3513
Mailing address:
  • Phone: 910-525-5115
  • Fax: 910-525-3513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
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