Provider Demographics
NPI:1336305960
Name:CAMP, LANESHIA SHANTE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LANESHIA
Middle Name:SHANTE
Last Name:CAMP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W PONCE DE LEON AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2483
Mailing Address - Country:US
Mailing Address - Phone:404-381-1840
Mailing Address - Fax:404-341-9488
Practice Address - Street 1:315 W PONCE DE LEON AVE STE 200
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2483
Practice Address - Country:US
Practice Address - Phone:404-381-1840
Practice Address - Fax:404-341-9488
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX257711223P0221X
GADN0142421223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADNO14242OtherDENTAL LICENSE