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General NPI Number Information
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NPI Number | 1669466736
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Entity Type | Individual
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Provider Name | ANDREW LANE D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2005
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Last Update Date | 09/23/2025
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Provider Practice Location Address
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Address Line | 5515 W 38TH ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46254-2995
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Country | US
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Telephone | 317-880-3838
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 637764
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City | CINCINNATI
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State | OH
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Zip | 45263-7764
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Country | US
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Telephone | 317-880-3939
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Fax |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 12010414A
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License Number State | IN
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