Provider Demographics
NPI:1295042836
Name:LANIER DENTAL LLC
Entity Type:Organization
Organization Name:LANIER DENTAL LLC
Other - Org Name:NEW YORK DENTAL SPECIALTIES GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARIANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:VALERIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:914-747-4700
Mailing Address - Street 1:110 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570-2838
Mailing Address - Country:US
Mailing Address - Phone:914-747-4700
Mailing Address - Fax:914-747-0437
Practice Address - Street 1:110 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570-2838
Practice Address - Country:US
Practice Address - Phone:914-747-4700
Practice Address - Fax:914-747-0437
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANIER DENTAL LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY02914911223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty