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General NPI Number Information
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NPI Number | 1447688924
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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 | 10/21/2013
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Last Update Date | 10/21/2013
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Provider Practice Location Address
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Address Line | 1200 SAVIERS RD
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City | OXNARD
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State | CA
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Zip | 93030
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Country | US
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Telephone | 323-461-9942
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Fax |
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Provider Business Mailing Address
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Address Line | 4905 HOLLYWOOD BLVD
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City | LOS ANGELES
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State | CA
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Zip | 90027-6101
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Country | US
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Telephone | 323-461-9942
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Fax |
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Authorized Official
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Title or Position | CEO/PRESIDENT
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Name | JERRY L LANIER
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Credential | DDS
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Telephone | 323-461-9942
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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 |
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License Number State |
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