Provider Demographics
NPI:1477974699
Name:JERRY L LANIER, DDS, INC
Entity Type:Organization
Organization Name:JERRY L LANIER, DDS, INC
Other - Org Name:KIDS DENTAL KARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-461-9942
Mailing Address - Street 1:14510 BALDWIN PARK TOWNE CTR STE G1
Mailing Address - Street 2:
Mailing Address - City:BALDWIN PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91706-5549
Mailing Address - Country:US
Mailing Address - Phone:323-461-9942
Mailing Address - Fax:323-331-3209
Practice Address - Street 1:4905 HOLLYWOOD BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6101
Practice Address - Country:US
Practice Address - Phone:323-461-9942
Practice Address - Fax:323-331-3209
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356489660Medicaid