Provider Demographics
NPI:1134182678
Name:LANZI, GUY L (DMD)
Entity type:Individual
Prefix:
First Name:GUY
Middle Name:L
Last Name:LANZI
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 1:15 E EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2300
Mailing Address - Country:US
Mailing Address - Phone:856-795-4600
Mailing Address - Fax:856-795-4697
Practice Address - Street 1:15 E EUCLID AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2300
Practice Address - Country:US
Practice Address - Phone:856-795-4600
Practice Address - Fax:856-795-4697
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0150891223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ160443TDKMedicare ID - Type Unspecified
NJU24713Medicare UPIN