Provider Demographics
NPI:1801905500
Name:LANESE, NICOLA (DDS)
Entity type:Individual
Prefix:DR
First Name:NICOLA
Middle Name:
Last Name:LANESE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6502 BANDERA RD
Mailing Address - Street 2:STE 201
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78238-1454
Mailing Address - Country:US
Mailing Address - Phone:210-684-5040
Mailing Address - Fax:210-682-7785
Practice Address - Street 1:6502 BANDERA RD
Practice Address - Street 2:STE 201
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1454
Practice Address - Country:US
Practice Address - Phone:210-684-5040
Practice Address - Fax:210-682-7785
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist