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General NPI Number Information
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NPI Number | 1043444276
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Entity Type | Organization
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Legal Business Name | JERRY L LANIER DDS INC.
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Dates
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Enumeration Date | 05/01/2009
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Last Update Date | 05/01/2009
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Provider Practice Location Address
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Address Line | 10900 LONG BEACH BLVD
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City | LYNWOOD
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State | CA
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Zip | 90262-2688
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Country | US
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Telephone | 310-632-0202
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Fax |
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Provider Business Mailing Address
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Address Line | 10900 LONG BEACH BLVD
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City | LYNWOOD
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State | CA
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Zip | 90262-2688
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Country | US
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Telephone | 310-632-0202
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. JERRY LANIER
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Credential | DDS
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Telephone | 310-632-0202
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 40088
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License Number State | CA
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