Jonathan Daniel Lane, DMD

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

DS039289 Issued in PA

Practice address

38717 38TH Street
Dentac Credentials Office
Fort Gordon, GA 30905-5660

Phone

(706) 787-6927

Fax

(706) 787-2082

NPI assigned

Aug 8, 2012

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1344384000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1469491200000",
    "number": "1164779294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "MIL",
            "address_1": "HQ, 618TH DENTAL COMPANY (AS)",
            "address_2": "UNIT #15652, BLDG S-5403",
            "city": "APO",
            "state": "AP",
            "postal_code": "962055652",
            "telephone_number": "011-822-2600",
            "fax_number": "315-737-2600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "38717 38TH STREET",
            "address_2": "DENTAC CREDENTIALS OFFICE",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055660",
            "telephone_number": "706-787-6927",
            "fax_number": "706-787-2082"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANE",
        "first_name": "JONATHAN",
        "middle_name": "DANIEL",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-08-08",
        "last_updated": "2016-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "PA",
            "license": "DS039289",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "PA",
            "license": "DS039289",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Urmila Kosuri, M.D
• Siang-Chean Kua, MD
• Agnieszka Kucharska-Frania, DDS
• Julie Kujawa
• Anton Peter Lacap, M.D., M.P.H.
• Shawn Douglas Lantz, CRNA
• Constance Larson, MD
• Alexis L Lauria, MD
• Daniel Joe Lavengood
• Constance Ann Lavieri-Reynolds, M.D.

• Periodontics in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Periodontics in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.