Healthcare Provider Details

I. General information

NPI: 1568452530
Provider Name (Legal Business Name): LANZ & NASON, DDS, MS, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 E GARRISON BLVD
GASTONIA NC
28054-5139
US

IV. Provider business mailing address

1601D E GARRISON BLVD
GASTONIA NC
28054-5130
US

V. Phone/Fax

Practice location:
  • Phone: 704-866-8281
  • Fax: 704-866-8489
Mailing address:
  • Phone: 704-866-8281
  • Fax: 704-866-8489

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number5402
License Number StateNC

VIII. Authorized Official

Name: JOHN C LANZ
Title or Position: PRESIDENT
Credential: D.D.S.
Phone: 704-866-8281