Provider Demographics
NPI:1972654655
Name:LANE AND ASSOCIATES VII, DDS PA
Entity type:Organization
Organization Name:LANE AND ASSOCIATES VII, DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMPTROLLER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:MORAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-814-2944
Mailing Address - Street 1:102 SOUTH MAIN ST.
Mailing Address - Street 2:PO BOX 2227
Mailing Address - City:LILLINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27546
Mailing Address - Country:US
Mailing Address - Phone:910-893-1096
Mailing Address - Fax:910-814-1559
Practice Address - Street 1:102 SOUTH MAIN ST.
Practice Address - Street 2:BOX 2227
Practice Address - City:LILLINGTON
Practice Address - State:NC
Practice Address - Zip Code:27546
Practice Address - Country:US
Practice Address - Phone:910-893-1096
Practice Address - Fax:910-814-1559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC47851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC690257KMedicaid
NC0257KOtherBCBS-NC HEALTHCHOICE
NC1378595OtherUNITED CONCORDIA