MEDICARE: JAMES CLAYTON LANHAM DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	DN11835	FL
2	122300000X	Dentist	2920	WV

General Provider Information

NPI Number	:	1952408155
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES CLAYTON LANHAM DDS

Provider Business Mailing Address
First Line	:	115 EAST PALM DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-2645
Country	:	US
Telephone Number	:	863-688-1867
Fax Number	:

Provider Business Practice Location Address
First Line	:	115 EAST PALM DR
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33803-2645
Country	:	US
Telephone Number	:	863-688-1867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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