Provider Demographics
NPI:1932643129
Name:DR. SANDRA T. LANTER
Entity Type:Organization
Organization Name:DR. SANDRA T. LANTER
Other - Org Name:RESTORATION DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:TINSLEY
Authorized Official - Last Name:LANTER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:205-338-0475
Mailing Address - Street 1:4402 COGSWELL AVE
Mailing Address - Street 2:
Mailing Address - City:PELL CITY
Mailing Address - State:AL
Mailing Address - Zip Code:35125-2702
Mailing Address - Country:US
Mailing Address - Phone:205-338-0475
Mailing Address - Fax:205-338-0528
Practice Address - Street 1:4402 COGSWELL AVE
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-2702
Practice Address - Country:US
Practice Address - Phone:205-338-0475
Practice Address - Fax:205-338-0528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-07
Last Update Date:2016-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL4745122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty