MEDICARE: CAITLIN LANZON DDS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	65049	CA

General Provider Information

NPI Number	:	1215477971
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAITLIN LANZON DDS INC.

Provider Business Mailing Address
First Line	:	5249 MISSION OAKS BLVD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5403
Country	:	US
Telephone Number	:	805-987-0245
Fax Number	:	805-910-3931

Provider Business Practice Location Address
First Line	:	5249 MISSION OAKS BLVD
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5403
Country	:	US
Telephone Number	:	805-987-0245
Fax Number	:	805-910-3931

Authorized Official
Title or Position	:	PRESIDENT
Name	:	CAITLIN LANZON
Credential	:
Telephone Number	:	805-987-0245

Provider Enumeration Date	:	02/28/2017
Last Update Date	:	02/28/2017

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