Provider Demographics
NPI:1447085758
Name:LANIE DENTAL LLC
Entity type:Organization
Organization Name:LANIE DENTAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MEGAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LANIE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:765-414-8327
Mailing Address - Street 1:15215 S 48TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-9137
Mailing Address - Country:US
Mailing Address - Phone:480-961-3330
Mailing Address - Fax:
Practice Address - Street 1:15215 S 48TH ST STE 113
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-9137
Practice Address - Country:US
Practice Address - Phone:480-961-3330
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty