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General NPI Number Information
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NPI Number | 1679626832
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Entity Type | Organization
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Legal Business Name | LANE AND ASSOCIATES IX DDS PA
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 02/21/2023
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Provider Practice Location Address
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Address Line | 131 MONTGOMERY XING
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City | BISCOE
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State | NC
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Zip | 27209
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Country | US
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Telephone | 910-428-2048
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Fax | 910-428-2328
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Provider Business Mailing Address
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Address Line | 131 MONTGOMERY XING
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City | BISCOE
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State | NC
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Zip | 27209
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Country | US
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Telephone | 910-428-2048
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Fax | 910-428-2328
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | ALICIA MARIE DUFFY
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Credential |
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Telephone | 919-295-2757
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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 | 4785
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License Number State | NC
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