Healthcare Provider Details

I. General information

NPI: 1881310001
Provider Name (Legal Business Name): LANE AND ASSOCIATES XLVIII DDS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2022
Last Update Date: 11/16/2022
Certification Date: 11/16/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

441 S MORGAN ST
ROXBORO NC
27573-5123
US

IV. Provider business mailing address

441 S MORGAN ST
ROXBORO NC
27573-5123
US

V. Phone/Fax

Practice location:
  • Phone: 336-599-6641
  • Fax:
Mailing address:
  • Phone: 336-599-6641
  • 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
# 3
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

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