Brian Lane
Individual provider Active NPI General Practice Dentistry · Vilonia, AR
NPI 1710072277 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1710072277
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 3395 (AR)
- Practice address
- 17 Eagle Park
Vilonia, AR 72173 - Phone
- (501) 796-3903
- NPI assigned
- Oct 3, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3395 | AR | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brian Lane D D S PA | Past |
Accepting new patients | |
| 17 Eagle Vilonia Professional LLC | General Practice | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 3395 | AR | Yes |
Addresses
Primary practice location
17 Eagle Park
Vilonia, AR 72173
Mailing address
PO Box 130
Vilonia, AR 72173
Other providers in Vilonia, AR
- Tracy L Howard
- Wendy Lee Janski
- Jda Therapy and Wellness Services
- Drew Keller
- Kelly Stephens Counseling, LLC
- Crystal Lee
- Maranda Marie Leonard
- Sherri Lorene Lewis
- David Justin Manning
- Kathryn Marsden
All providers in Vilonia, AR · General Practice Dentistry in Arkansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.