Provider Demographics
NPI:1447318464
Name:LANE, LAMAR W JR (DDS)
Entity type:Individual
Prefix:DR
First Name:LAMAR
Middle Name:W
Last Name:LANE
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:3801 WOODLAND HEIGHTS RD
Mailing Address - Street 2:SUITE 175
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72212
Mailing Address - Country:US
Mailing Address - Phone:501-224-1004
Mailing Address - Fax:501-224-1005
Practice Address - Street 1:3801 WOODLAND HEIGHTS
Practice Address - Street 2:SUITE 175
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72212
Practice Address - Country:US
Practice Address - Phone:501-224-1004
Practice Address - Fax:501-224-1005
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AR33791223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR841003OtherUNITED CONCORDIA
AR5Y757OtherBLUE CROSS