Provider Demographics
NPI:1982738803
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:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-780-0009
Mailing Address - Street 1:4900 WHITTIER BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90022-3115
Mailing Address - Country:US
Mailing Address - Phone:323-780-0009
Mailing Address - Fax:323-780-9744
Practice Address - Street 1:4900 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90022-3115
Practice Address - Country:US
Practice Address - Phone:323-780-0009
Practice Address - Fax:323-780-9744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA400881223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty