Organization
LANIER ORTHODONTICS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYM MADDOX (CORPORATE SECRETARY)
(770) 532-8104
Entity
Organization
Contact information
Practice address
1215 SHERWOOD PARK DR NE, GAINESVILLE, GA 30501-3444
(770) 532-4156
(770) 536-1529
Mailing address
1215 SHERWOOD PARK DR NE, GAINESVILLE, GA 30501-3444
(770) 532-4156
(770) 536-1529
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
DN011067
GA
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
DN011899
GA
Other
Enumeration date
10/10/2006
Last updated
08/22/2020
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