Individual provider · Type 1 NPI
Jonathan Daniel Lane, DMD
Periodontics · Fort Gordon, GA
Practice location
38717 38th Street, Dentac Credentials Office
Fort Gordon, GA 30905-5660
Fax (706) 787-2082
Mailing address
Hq, 618th Dental Company (as), Unit #15652, Bldg S-5403
Apo, AP 96205-5652
Specialties and licenses
| Taxonomy | Code | License |
|---|---|---|
| Dentist | 122300000X | DS039289 (PA) |
| Periodontics Primary | 1223P0300X | DS039289 (PA) |
Periodontics: That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues.
2 other providers at this address
Other periodontics providers in Fort Gordon
- Frederick Charles Bisch, DMDPeriodontics Fort Gordon, GA NPI 1033196159
- Dan Melbourne Prucha, DDSPeriodontics Fort Gordon, GA NPI 1174509202
- Adam Randal Lincicum, DMDPeriodontics Fort Gordon, GA NPI 1326279274
- Robert William Herold, DDSPeriodontics Fort Gordon, GA NPI 1609853654
- Anthony A. Vargas, DDSPeriodontics Fort Gordon, GA NPI 1699220384
- Thomas Michael Johnson, DMD, MSPeriodontics Fort Gordon, GA NPI 1780662791
About NPI 1164779294
Jonathan Daniel Lane, DMD's National Provider Identifier is 1164779294, issued on Aug 8, 2012. The primary taxonomy on file is Periodontics (1223P0300X), and the practice location is in Fort Gordon, GA. The record was last updated on Jul 26, 2016.