NPIMap

Organization Active NPI

Lane & Associates DDS Xvii PA

  • General Practice Dentistry
  • Garner, NC
National Provider Identifier
1720131972
Registry record updated Feb 21, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
4785 Issued in NC
Legal business name
LANE & ASSOCIATES DDS XVII PA
Practice address
12450 Cleveland Rd Ste 100
Garner, NC 27529-8355
Phone
(919) 772-9927
Fax
(919) 772-0647
NPI assigned
Jan 19, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2023

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

Authorized official

Name
Alicia Marie Duffy
Title
Credentialing Manager
Phone
(919) 295-2757

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 4785 NC Primary

Addresses

Primary practice location

12450 Cleveland Rd Ste 100
Garner, NC 27529-8355

Mailing address

12450 Cleveland Rd
Ste 204
Garner, NC 27529
Phone (919) 295-2757

Other identifiers 2

IdentifierTypeStateIssuer
5902254MedicaidNC
017K1OtherNCBCBS-NC HEALTHCHOICE

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1676937600000",
    "number": "1720131972",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12450 CLEVELAND RD",
            "address_2": "STE 204",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "27529",
            "telephone_number": "919-295-2757",
            "fax_number": "919-295-2757"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12450 CLEVELAND RD STE 100",
            "city": "GARNER",
            "state": "NC",
            "postal_code": "275298355",
            "telephone_number": "919-772-9927",
            "fax_number": "919-772-0647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANE & ASSOCIATES DDS XVII PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-19",
        "last_updated": "2023-02-21",
        "certification_date": "2023-02-21",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "919-295-2757"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "4785",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5902254",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-NC HEALTHCHOICE",
            "identifier": "017K1",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Garner, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2023; 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.