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General NPI Number Information
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NPI Number | 1508954116
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Entity Type | Organization
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Legal Business Name | LANIER ORTHODONTICS PA
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Dates
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Enumeration Date | 10/10/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1215 SHERWOOD PARK DR NE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3444
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Country | US
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Telephone | 770-532-4156
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Fax | 770-536-1529
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Provider Business Mailing Address
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Address Line | 1215 SHERWOOD PARK DR NE
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City | GAINESVILLE
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State | GA
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Zip | 30501-3444
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Country | US
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Telephone | 770-532-4156
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Fax | 770-536-1529
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Authorized Official
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Title or Position | CORPORATE SECRETARY
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Name | KYM MADDOX
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Credential |
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Telephone | 770-532-8104
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN011899
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN011067
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License Number State | GA
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