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General NPI Number Information
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NPI Number | 1588054779
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Entity Type | Organization
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Legal Business Name | LANE EDDLEMAN, DDS, LLC
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Dates
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Enumeration Date | 01/27/2015
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Last Update Date | 10/07/2025
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Provider Practice Location Address
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Address Line | 2511 BROADMOOR BLVD
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-322-2013
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Fax | 318-322-2048
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Provider Business Mailing Address
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Address Line | 2511 BROADMOOR BLVD
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-322-2013
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Fax | 318-322-2048
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Authorized Official
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Title or Position | PAYER ENROLLMENT MANAGER
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Name | JENNY GARCIA-ROCHA
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Credential |
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Telephone | 972-869-3789
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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 |
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License Number State |
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