Provider Demographics
NPI:1063728376
Name:LANE, ADAM J (DDS)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:J
Last Name:LANE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4323 HILL ST
Mailing Address - Street 2:USA DENTAC
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29207-6022
Mailing Address - Country:US
Mailing Address - Phone:803-751-6209
Mailing Address - Fax:803-751-6886
Practice Address - Street 1:4323 HILL ST
Practice Address - Street 2:4323 HILL STREET
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-6022
Practice Address - Country:US
Practice Address - Phone:803-751-6209
Practice Address - Fax:803-751-6886
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2019-02-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC87721223E0200X
GADN0151321223E0200X
CADDS1034891223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics