Provider Demographics
NPI:1366695397
Name:AMANDA WELLS LANIER, D.M.D., P.C.
Entity type:Organization
Organization Name:AMANDA WELLS LANIER, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:WELLS
Authorized Official - Last Name:LANIER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:334-493-3773
Mailing Address - Street 1:602 BRANTLEY ST
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1742
Mailing Address - Country:US
Mailing Address - Phone:334-493-3773
Mailing Address - Fax:334-493-9785
Practice Address - Street 1:602 BRANTLEY ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1742
Practice Address - Country:US
Practice Address - Phone:334-493-3773
Practice Address - Fax:334-493-9785
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-04
Last Update Date:2008-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL5236122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty