Provider Demographics
NPI:1558027573
Name:LANZI, KELLI (RDH)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:LANZI
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:194 TALMONT CIR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95678-6059
Mailing Address - Country:US
Mailing Address - Phone:916-704-5818
Mailing Address - Fax:
Practice Address - Street 1:194 TALMONT CIR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-6059
Practice Address - Country:US
Practice Address - Phone:916-704-5818
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-14
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25463124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25463OtherREGISTERED DENTAL HYGIENIEST