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DR. BRIAN LANE

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1710072277

Individual Registrant:
DR. BRIAN  LANE 
Gender: M
Sole Proprietor

Location and contact information for practice:
17 EAGLE PARK  VILONIA, AR 72173 US
Tel: 501-796-3903  Fax: --

Contact information for business:
PO BOX 130  VILONIA, AR 72173 US
Tel: --  Fax: --

Registration Information:
NPI: 1710072277
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
AR3395

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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