Dr. Brian Lane
Dentist, General Practice in Vilonia, AR. Individual provider (NPI-1).
NPI number1710072277
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1710072277
- Entity type
- Individual (NPI-1)
- Name
- Dr. Brian Lane
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Oct 3, 2006
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 3395 | AR | Yes |
Practice location
17 Eagle ParkVilonia, AR 72173
Phone 501-796-3903
Mailing address
Po Box 130Vilonia, AR 72173
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