Healthcare Provider Details

I. General information

NPI: 1205802345
Provider Name (Legal Business Name): CHRISTOPHER JOSEPH LANE DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 02/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 CHURCH ST SUITE 404
WHITE PLAINS NY
10601-1515
US

IV. Provider business mailing address

95 CHURCH ST SUITE 404
WHITE PLAINS NY
10601-1515
US

V. Phone/Fax

Practice location:
  • Phone: 914-946-1249
  • Fax:
Mailing address:
  • Phone: 914-946-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number042192
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: