Provider Demographics
NPI:1548271786
Name:HARRIS, LANE S (DMD)
Entity type:Individual
Prefix:DR
First Name:LANE
Middle Name:S
Last Name:HARRIS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 ELM ST SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2039
Mailing Address - Country:US
Mailing Address - Phone:541-928-2993
Mailing Address - Fax:541-926-0339
Practice Address - Street 1:1036 ELM ST SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2039
Practice Address - Country:US
Practice Address - Phone:541-928-2993
Practice Address - Fax:541-926-0339
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR7193122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist