Provider Demographics
NPI:1609286574
Name:LANIER DENTAL GROUP, INC
Entity Type:Organization
Organization Name:LANIER DENTAL GROUP, INC
Other - Org Name:MOUNTAIN VIEW DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:WITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS MAGD
Authorized Official - Phone:770-331-9480
Mailing Address - Street 1:5458 S CHESTATEE
Mailing Address - Street 2:
Mailing Address - City:DAHLONEGA
Mailing Address - State:GA
Mailing Address - Zip Code:30533
Mailing Address - Country:US
Mailing Address - Phone:706-864-9800
Mailing Address - Fax:706-864-9801
Practice Address - Street 1:5458 S CHESTATEE
Practice Address - Street 2:
Practice Address - City:DAHLONEGA
Practice Address - State:GA
Practice Address - Zip Code:30533
Practice Address - Country:US
Practice Address - Phone:706-864-9800
Practice Address - Fax:706-864-9801
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LANIER DENTAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-05-01
Last Update Date:2014-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN009608261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental