Provider Demographics
NPI:1154532935
Name:DON G LANE DDS,PLLC
Entity type:Organization
Organization Name:DON G LANE DDS,PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:T
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-892-4535
Mailing Address - Street 1:596B EAST JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:NC
Mailing Address - Zip Code:28339
Mailing Address - Country:US
Mailing Address - Phone:910-892-4535
Mailing Address - Fax:910-892-0255
Practice Address - Street 1:598 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:NC
Practice Address - Zip Code:28339-9629
Practice Address - Country:US
Practice Address - Phone:910-892-4535
Practice Address - Fax:910-892-0255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC4785122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty