Healthcare Provider Details

I. General information

NPI: 1043357734
Provider Name (Legal Business Name): LANEY DENTAL LAB INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 BRIDGE STREET
BRIDGEWATER PA
15009-2908
US

IV. Provider business mailing address

413 BRIDGE STREET
BRIDGEWATER PA
15009-2908
US

V. Phone/Fax

Practice location:
  • Phone: 724-728-2161
  • Fax: 724-728-5122
Mailing address:
  • Phone: 724-728-2161
  • Fax: 724-728-5122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code292200000X
TaxonomyDental Laboratory
License Number
License Number State

VIII. Authorized Official

Name: CINDY K LANEY
Title or Position: V PRESIDENT SECRETARY
Credential:
Phone: 424-728-2161