Provider Demographics
NPI:1548941339
Name:ANDERSON, LANE THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:LANE
Middle Name:THOMAS
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8543 ROE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-1839
Mailing Address - Country:US
Mailing Address - Phone:816-398-2652
Mailing Address - Fax:
Practice Address - Street 1:4911 S ARROWHEAD DR STE 300
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7018
Practice Address - Country:US
Practice Address - Phone:816-373-4440
Practice Address - Fax:816-795-6732
Is Sole Proprietor?:No
Enumeration Date:2023-07-26
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023028438122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist