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DR. KEETH MARVIN LANE DDS

General Practice >> Dentist >> Dental Providers

Registrant NPI Number: 1780843284

Individual Registrant:
DR. KEETH MARVIN LANE DDS
Gender: M
Not Sole Proprietor

Location and contact information for practice:
18100 HIGHWAY 104  ROBERTSDALE, AL 36567-8734 US
Tel: 251-947-5940  Fax: 251-947-5942

Contact information for business:
18100 HIGHWAY 104  ROBERTSDALE, AL 36567-8734 US
Tel: 251-947-5940  Fax: 251-947-5942

Registration Information:
NPI: 1780843284
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y1223G0001XDental Providers
Dentist
General Practice
AL4306

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType




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