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General NPI Number Information
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NPI Number | 1306006986
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Entity Type | Individual
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Provider Name | ROBERT PERSON LANE DDS
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Gender | Male
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Dates
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Enumeration Date | 06/17/2008
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Last Update Date | 10/23/2018
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Provider Practice Location Address
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Address Line | 4561 MILLBRANCH RD STE 1
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City | MEMPHIS
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State | TN
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Zip | 38116-7437
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Country | US
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Telephone | 901-396-5700
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Fax | 347-442-3138
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Provider Business Mailing Address
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Address Line | 4561 MILLBRANCH RD STE 1
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City | MEMPHIS
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State | TN
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Zip | 38116-7437
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Country | US
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Telephone | 901-396-5700
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Fax | 347-442-3138
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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 | 047164
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 008551
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License Number State | TN
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