MEDICARE: ROBERT PERSON LANE DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	047164	NY
2	1223G0001X	General Practice Dentistry	008551	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1306006986
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT PERSON LANE DDS

Provider Business Mailing Address
First Line	:	4561 MILLBRANCH RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-7437
Country	:	US
Telephone Number	:	901-396-5700
Fax Number	:	347-442-3138

Provider Business Practice Location Address
First Line	:	4561 MILLBRANCH RD STE 1
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38116-7437
Country	:	US
Telephone Number	:	901-396-5700
Fax Number	:	347-442-3138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	10/23/2018

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Directions to “ ROBERT PERSON LANE DDS” Practice Location

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