Provider Demographics
NPI:1568522654
Name:LANZ, DWAYNE A (DMD)
Entity Type:Individual
Prefix:
First Name:DWAYNE
Middle Name:A
Last Name:LANZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 PERKIOMEN AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-1865
Mailing Address - Country:US
Mailing Address - Phone:610-779-5123
Mailing Address - Fax:610-779-9408
Practice Address - Street 1:2128 PERKIOMEN AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-1865
Practice Address - Country:US
Practice Address - Phone:610-779-5123
Practice Address - Fax:610-779-9408
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027262-L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice