Provider Demographics
NPI:1750535001
Name:THOMAS JOACHIM LANEY MD DDS PS
Entity type:Organization
Organization Name:THOMAS JOACHIM LANEY MD DDS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOACHIM
Authorized Official - Last Name:LANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD DDS
Authorized Official - Phone:509-765-5141
Mailing Address - Street 1:1308 S PIONEER WAY
Mailing Address - Street 2:
Mailing Address - City:MOSES LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:98837-2410
Mailing Address - Country:US
Mailing Address - Phone:509-765-5141
Mailing Address - Fax:509-765-5891
Practice Address - Street 1:1308 S PIONEER WAY
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2410
Practice Address - Country:US
Practice Address - Phone:509-765-5141
Practice Address - Fax:509-765-5891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-13
Last Update Date:2008-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00024468261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5005343Medicaid
WA1035674Medicaid
WA0141393OtherDEPT OF LABOR & INDUSTRIES
WAGAB37116Medicare PIN