Organization
CENTRE OF PANOLA COSMETIC & FAMILY DENTISTRY P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IDA LANIER DDS (PRESIDENT)
(770) 498-3744
Entity
Organization
Contact information
Practice address
3035 PANOLA RD STE A, LITHONIA, GA 30038-2494
(770) 498-3744
Mailing address
3035 PANOLA RD STE A, LITHONIA, GA 30038-2494
(770) 498-3744
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
10/17/2024
Last updated
10/17/2024
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