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General NPI Number Information
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NPI Number | 1932268216
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Entity Type | Organization
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Legal Business Name | LANIER DENTAL GROUP INC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 09/27/2012
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Provider Practice Location Address
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Address Line | 819 THOMPSON BRIDGE ROAD
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-535-8900
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Fax | 770-535-8108
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Provider Business Mailing Address
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Address Line | 819 THOMPSON BRIDGE ROAD
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City | GAINESVILLE
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State | GA
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Zip | 30501
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Country | US
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Telephone | 770-535-8900
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Fax | 770-535-8108
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Authorized Official
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Title or Position | DENTIST OWNER
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Name | DR. MICHAEL D WITHCER
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Credential | DDS
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Telephone | 770-535-8900
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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 | DN0009359
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 9608
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License Number State | GA
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