Healthcare Provider Details

I. General information

NPI: 1073477824
Provider Name (Legal Business Name): JERRY L LANIER DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W SHAW AVE STE 101
CLOVIS CA
93612-3698
US

IV. Provider business mailing address

5449 HOLLYWOOD BLVD STE A
LOS ANGELES CA
90027-3454
US

V. Phone/Fax

Practice location:
  • Phone: 559-691-4591
  • Fax: 559-691-4592
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE LOBO
Title or Position: HR DIRECTOR
Credential:
Phone: 661-312-1433