Provider Demographics
NPI:1053751214
Name:LANE, ANNE ATHA (DDS)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:ATHA
Last Name:LANE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10400 W 103RD ST STE 21
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66214-2664
Mailing Address - Country:US
Mailing Address - Phone:913-722-0610
Mailing Address - Fax:913-722-2893
Practice Address - Street 1:10400 W 103RD ST STE 21
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66214-2664
Practice Address - Country:US
Practice Address - Phone:913-722-0610
Practice Address - Fax:913-722-2893
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRES.3374390200000X
KS690591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program