Provider Demographics
NPI:1932268216
Name:LANIER DENTAL GROUP INC
Entity type:Organization
Organization Name:LANIER DENTAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:WITHCER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:770-535-8900
Mailing Address - Street 1:819 THOMPSON BRIDGE ROAD
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501
Mailing Address - Country:US
Mailing Address - Phone:770-535-8900
Mailing Address - Fax:770-535-8108
Practice Address - Street 1:819 THOMPSON BRIDGE ROAD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501
Practice Address - Country:US
Practice Address - Phone:770-535-8900
Practice Address - Fax:770-535-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN0009359122300000X
GA9608122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty