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General NPI Number Information
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NPI Number | 1386861078
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Entity Type | Individual
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Provider Name | KERRY JURGENS LANE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 04/20/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 325 MEETING HOUSE LANE SUITE H
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City | SOUTHAMPTON
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State | NY
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Zip | 11946
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Country | US
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Telephone | 631-283-1543
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Fax | 631-287-4598
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Provider Business Mailing Address
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Address Line | 325 MEETING HOUSE LN SUITE H
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City | SOUTHAMPTON
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State | NY
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Zip | 11968-5087
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Country | US
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Telephone | 631-283-1543
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Fax | 631-287-4598
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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 | 042010-1
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License Number State | NY
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