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Organization
LANIER BURBANK DENTAL GROUP INC.
Active
Organization
LANIER BURBANK DENTAL GROUP INC.
Active
Other names
Kids Dental Kare
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JERRY LEE LANIER DDS (PRESIDENT/CEO)
(323) 461-9942
Entity
Organization
Contact information
Practice address
1400 W OLIVE AVE, SUITE 201, BURBANK, CA 91506-2409
(323) 461-9942
(323) 461-8147
Mailing address
4905 HOLLYWOOD BLVD, LOS ANGELES, CA 90027-6101
(323) 461-9942
(323) 461-8147
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
B40088
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B40088
—
CA
Enumeration date
04/23/2010
Last updated
04/23/2010
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