NPIMap

Organization Active NPI

Lane and Associates XII DDS PA

  • General Practice Dentistry
  • Raleigh, NC
National Provider Identifier
1811041700
Registry record updated Nov 27, 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 AND ASSOCIATES XII DDS PA
Practice address
4106 Wake Forest Rd Ste 100
Raleigh, NC 27609-6397
Phone
(919) 876-2464
Fax
(919) 876-1409
NPI assigned
Jan 22, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Alicia 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

4106 Wake Forest Rd Ste 100
Raleigh, NC 27609-6397

Mailing address

4106 Wake Forest Rd
Suite 100
Raleigh, NC 27609-6227
Phone (919) 876-2464

Other identifiers 2

IdentifierTypeStateIssuer
016YFOtherNCBCBS-NC HEALTHCHOICE
89016TJMedicaidNC

Other names 1

  • Lane and Associates XII Former legal business name

National Provider Directory

National Provider Directory

Locations

4106 Wake Forest Rd
Ste 100
Raleigh, NC 27609
Phone (919) 876-2464

Practitioners & affiliated clinicians

Practitioners 11

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": "1169424000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1811041700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 WAKE FOREST RD",
            "address_2": "SUITE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096227",
            "telephone_number": "919-876-2464",
            "fax_number": "919-876-1409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 WAKE FOREST RD STE 100",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276096397",
            "telephone_number": "919-876-2464",
            "fax_number": "919-876-1409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LANE AND ASSOCIATES XII DDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-22",
        "last_updated": "2023-11-27",
        "certification_date": "2023-11-27",
        "status": "A",
        "authorized_official_last_name": "DUFFY",
        "authorized_official_first_name": "ALICIA",
        "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": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-NC HEALTHCHOICE",
            "identifier": "016YF",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89016TJ",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lane and Associates XII",
            "code": "4",
            "type": "Former Legal Business Name"
        },
        {
            "organization_name": "Lane and Associates XII",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Raleigh, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 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.