Provider Demographics
NPI:1538146253
Name:SMITH, LANEY MILLER (DMD)
Entity type:Individual
Prefix:MRS
First Name:LANEY
Middle Name:MILLER
Last Name:SMITH
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2712 HIGHWAY 34 E
Mailing Address - Street 2:
Mailing Address - City:NEWNAN
Mailing Address - State:GA
Mailing Address - Zip Code:30265-2195
Mailing Address - Country:US
Mailing Address - Phone:770-304-0082
Mailing Address - Fax:678-423-9191
Practice Address - Street 1:2712 HIGHWAY 34 E
Practice Address - Street 2:
Practice Address - City:NEWNAN
Practice Address - State:GA
Practice Address - Zip Code:30265-2195
Practice Address - Country:US
Practice Address - Phone:770-304-0082
Practice Address - Fax:678-423-9191
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0117211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice