Healthcare Provider Details

I. General information

NPI: 1750535001
Provider Name (Legal Business Name): THOMAS JOACHIM LANEY MD DDS PS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2008
Last Update Date: 11/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 S PIONEER WAY
MOSES LAKE WA
98837-2410
US

IV. Provider business mailing address

1308 S PIONEER WAY
MOSES LAKE WA
98837-2410
US

V. Phone/Fax

Practice location:
  • Phone: 509-765-5141
  • Fax: 509-765-5891
Mailing address:
  • Phone: 509-765-5141
  • Fax: 509-765-5891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS0112X
TaxonomyOral and Maxillofacial Surgery Clinic/Center
License NumberMD00024468
License Number StateWA

VIII. Authorized Official

Name: DR. THOMAS JOACHIM LANEY
Title or Position: OWNER
Credential: MD DDS
Phone: 509-765-5141