Provider Demographics
NPI:1518122522
Name:LANIER, KATRICE L (DMD)
Entity Type:Individual
Prefix:
First Name:KATRICE
Middle Name:L
Last Name:LANIER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:KATRICE
Other - Middle Name:L
Other - Last Name:REGISTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:48 VINING WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-9406
Mailing Address - Country:US
Mailing Address - Phone:229-588-1122
Mailing Address - Fax:
Practice Address - Street 1:101 E GENERAL STEWART WAY
Practice Address - Street 2:
Practice Address - City:HINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:31313
Practice Address - Country:US
Practice Address - Phone:912-368-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0137051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice