Healthcare Provider Details

I. General information

NPI: 1376749176
Provider Name (Legal Business Name): ANTONELLA BELLA LANZA DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANTONELLA RASHIDI DMD

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 03/31/2020
Certification Date: 03/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

FORT BELKNAP INDIAN COMMUNITY 656 AGENCY MAIN STREET
HARLEM MT
59526
US

IV. Provider business mailing address

PO BOX 413
HARLEM MT
59526-0413
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-2525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number46517
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number15532
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: