Provider Demographics
NPI:1972823904
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:OWNER
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:
Authorized Official - Phone:323-461-9942
Mailing Address - Street 1:1400 W OLIVE AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91506-2416
Mailing Address - Country:US
Mailing Address - Phone:818-748-2250
Mailing Address - Fax:
Practice Address - Street 1:1400 W OLIVE AVE STE 201
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91506-2416
Practice Address - Country:US
Practice Address - Phone:818-748-2250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-01
Last Update Date:2015-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356489660Medicaid