Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 15123 | TX |
NPI | 1063551216 |
---|---|
Provider Name | Dr. Patricia Anne Lanier |
First Address | Galveston, TX 77551 |
Second Address | Galveston, TX 77551 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DENT 24368 | (05) | TX |