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General NPI Number Information
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NPI Number | 1942357686
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Entity Type | Individual
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Provider Name | KATHERINE JEAN LANE D.M.D, M.S.D
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Gender | Female
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 06/26/2014
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Provider Practice Location Address
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Address Line | 5135 SKYLINE RD S
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City | SALEM
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State | OR
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Zip | 97306-9427
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Country | US
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Telephone | 541-880-2090
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Fax | 541-880-2092
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Provider Business Mailing Address
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Address Line | 5111 ZOSEL AVE S
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City | SALEM
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State | OR
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Zip | 97306-2103
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Country | US
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Telephone | 503-866-0920
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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 | D8774
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License Number State | OR
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Taxonomy #2
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D8774
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License Number State | OR
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