Healthcare Provider Details

I. General information

NPI: 1467686592
Provider Name (Legal Business Name): JERRY L LANIER DDS INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14101 PARAMOUNT BLVD
PARAMOUNT CA
90723-2607
US

IV. Provider business mailing address

14101 PARAMOUNT BLVD
PARAMOUNT CA
90723-2607
US

V. Phone/Fax

Practice location:
  • Phone: 562-529-8526
  • Fax:
Mailing address:
  • Phone: 562-529-8526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number40088
License Number StateCA

VIII. Authorized Official

Name: DR. JERRY LANIER
Title or Position: PRESIDENT/DENTIST
Credential: DDS
Phone: 562-529-8526