MEDICARE: JERRY L LANIER DDS INC.

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	1223G0001X	General Practice Dentistry	40088	CA

General Provider Information

NPI Number	:	1982738803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JERRY L LANIER DDS INC.

Provider Business Mailing Address
First Line	:	4900 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3115
Country	:	US
Telephone Number	:	323-780-0009
Fax Number	:	323-780-9744

Provider Business Practice Location Address
First Line	:	4900 WHITTIER BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-3115
Country	:	US
Telephone Number	:	323-780-0009
Fax Number	:	323-780-9744

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JERRY LEE LANIER
Credential	:
Telephone Number	:	323-780-0009

Provider Enumeration Date	:	03/15/2007
Last Update Date	:	07/10/2008

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