MEDICARE: TIA LANEZ JEFFERS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901016666	MI
2	122300000X	Dentist	DN123918	GA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568581866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIA LANEZ JEFFERS DDS

Provider Business Mailing Address
First Line	:	2795 LEE RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3358
Country	:	US
Telephone Number	:	269-445-3874
Fax Number	:	269-445-2076

Provider Business Practice Location Address
First Line	:	2795 LEE RD
Second Line	:
City	:	LITHIA SPRINGS
State	:	GA
Zip	:	30122-3358
Country	:	US
Telephone Number	:	978-513-7488
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2007
Last Update Date	:	03/20/2026

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