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General NPI Number Information
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NPI Number | 1649694415
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Entity Type | Organization
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Legal Business Name | JENNY LANE, DDS, MD, PLLC
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Dates
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Enumeration Date | 02/13/2014
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Last Update Date | 02/13/2014
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Provider Practice Location Address
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Address Line | 4 VANDERBILT PARK DR STE 210
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City | ASHEVILLE
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State | NC
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Zip | 28803-1759
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Country | US
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Telephone | 828-505-1960
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Fax |
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Provider Business Mailing Address
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Address Line | 4 VANDERBILT PARK DR STE 210
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City | ASHEVILLE
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State | NC
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Zip | 28803-1759
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | JENNIFER LANE
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Credential |
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Telephone | 205-908-7662
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number | 7770
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License Number State | NC
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