Provider Demographics
NPI:1710007984
Name:KANE, LAURIE (DDS)
Entity type:Individual
Prefix:DR
First Name:LAURIE
Middle Name:
Last Name:KANE
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8444 FAIRGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:WAXHAW
Mailing Address - State:NC
Mailing Address - Zip Code:28173-7071
Mailing Address - Country:US
Mailing Address - Phone:323-481-0674
Mailing Address - Fax:
Practice Address - Street 1:10460 PARK RD STE 101
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8536
Practice Address - Country:US
Practice Address - Phone:704-579-5440
Practice Address - Fax:980-785-9710
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA551971223G0001X
NC122741223P0221X
DEG1-00114771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice