| Brian Lane D D S Pa | |
|
17 Eagle Park Dr Vilonia AR 72173-9050 | |
| (501) 425-1583 | |
| Not Available |
| Full Name | Brian Lane D D S Pa |
|---|---|
| Speciality | Dentist |
| Location | 17 Eagle Park Dr, Vilonia, Arkansas |
| Authorized Official Name and Position | Brian Lane (PRESIDENT) |
| Authorized Official Contact | 5017963903 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brian Lane D D S Pa Po Box 130 Vilonia AR 72173-0130 Ph: (501) 796-3903 | Brian Lane D D S Pa 17 Eagle Park Dr Vilonia AR 72173-9050 Ph: (501) 425-1583 |
| NPI Number | 1831711910 |
|---|---|
| Provider Enumeration Date | 05/12/2020 |
| Last Update Date | 06/10/2020 |
| Medicare PECOS PAC ID | 6406278175 |
|---|---|
| Medicare Enrollment ID | O20200625001955 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831711910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | (* (Not Available)) | Primary |
Vilonia Family Dental Pllc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 1163 Main St Ste 106, Vilonia, AR 72173 Phone: 501-222-9144 |