Individual provider Active NPI

Ida Beatrice Lanier, DDS

  • Dentist
  • Lithonia, GA
National Provider Identifier
1164594032
Registry record updated Feb 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
11228 Issued in GA
Practice address
3035 Panola Rd Ste a
Lithonia, GA 30038-2494
Phone
(770) 593-3426
Fax
(770) 593-3672
NPI assigned
Nov 15, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 11228 GA Primary

Addresses

Primary practice location

3035 Panola Rd Ste a
Lithonia, GA 30038-2494

Mailing address

3035 Panola Rd Ste a
Lithonia, GA 30038-2494
Phone (770) 593-3426

Other identifiers 1

IdentifierTypeStateIssuer
00586154AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11228GAMDAnesthesiologist Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Centre of Panola Cosmetic & Family Dentistry P.C. CurrentSince Oct 20, 2024 Accepting new patients
New Smiles of Decatur Current Accepting new patients

Locations

3035 Panola Rd
Ste A
Stonecrest, GA 30038
Phone (770) 498-3744

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707782400000",
    "number": "1164594032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3035 PANOLA RD STE A",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300382494",
            "telephone_number": "770-593-3426",
            "fax_number": "770-593-3672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3035 PANOLA RD STE A",
            "city": "LITHONIA",
            "state": "GA",
            "postal_code": "300382494",
            "telephone_number": "770-593-3426",
            "fax_number": "770-593-3672"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LANIER",
        "first_name": "IDA",
        "middle_name": "BEATRICE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-15",
        "last_updated": "2024-02-13",
        "certification_date": "2024-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "GA",
            "license": "11228",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00586154A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lithonia, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.