Provider Demographics
NPI:1023230711
Name:LANE, HOLLY R (DDS)
Entity type:Individual
Prefix:
First Name:HOLLY
Middle Name:R
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 1:14400 JONES MALTSBERGER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3748
Mailing Address - Country:US
Mailing Address - Phone:210-545-3929
Mailing Address - Fax:210-545-5069
Practice Address - Street 1:14400 JONES MALTSBERGER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247-3748
Practice Address - Country:US
Practice Address - Phone:210-545-3929
Practice Address - Fax:210-545-5069
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX165141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice