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General NPI Number Information
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NPI Number | 1295926137
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Entity Type | Individual
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Provider Name | RONALD PAUL LANE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 08/06/2007
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Provider Practice Location Address
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Address Line | 1201 S ORTONVILLE RD
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City | ORTONVILLE
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State | MI
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Zip | 48462-8547
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Country | US
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Telephone | 248-627-2866
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Fax | 248-627-9954
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Provider Business Mailing Address
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Address Line | PO BOX 810
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City | ORTONVILLE
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State | MI
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Zip | 48462-0810
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Country | US
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Telephone | 248-627-2866
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Fax | 248-627-9954
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 13772
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License Number State | MI
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