Provider Demographics
NPI:1659609212
Name:LANIER DENTAL AT DAWSONVILLE, LLC
Entity Type:Organization
Organization Name:LANIER DENTAL AT DAWSONVILLE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WITCHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:706-265-0005
Mailing Address - Street 1:6625 HIGHWAY 53 E
Mailing Address - Street 2:SUITE 440
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-6838
Mailing Address - Country:US
Mailing Address - Phone:706-265-0005
Mailing Address - Fax:
Practice Address - Street 1:6625 HIGHWAY 53 E
Practice Address - Street 2:SUITE 440
Practice Address - City:DAWSONVILLE
Practice Address - State:GA
Practice Address - Zip Code:30534-6838
Practice Address - Country:US
Practice Address - Phone:706-265-0005
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2009-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty