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General NPI Number Information
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NPI Number | 1013133206
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Entity Type | Organization
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Legal Business Name | LANE CENTER FOR ADVANCED DENTISTRY, LLC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4623 STATE ROUTE 136
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City | GREENSBURG
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State | PA
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Zip | 15601-6415
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Country | US
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Telephone | 724-836-4433
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Fax | 724-836-2507
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Provider Business Mailing Address
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Address Line | 4623 STATE ROUTE 136
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City | GREENSBURG
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State | PA
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Zip | 15601-6415
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Country | US
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Telephone | 724-836-4433
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Fax | 724-836-2507
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | GREGORY EARL LANE
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Credential | D.M.D.
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Telephone | 724-836-4433
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS0272161
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License Number State | PA
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