Provider Demographics
NPI:1285040931
Name:LANNOM, CLARIAN (DDS)
Entity Type:Individual
Prefix:
First Name:CLARIAN
Middle Name:
Last Name:LANNOM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 W WATER ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:321 W WATER ST
Practice Address - Street 2:SUITE 115
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-4230
Practice Address - Country:US
Practice Address - Phone:830-896-8343
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX301641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice