Healthcare Provider Details

I. General information

NPI: 1205495512
Provider Name (Legal Business Name): LANZ PEDIATRIC DENTISTRY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2019
Last Update Date: 06/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3402 WASHINGTON RD STE 205
MC MURRAY PA
15317-2964
US

IV. Provider business mailing address

129 ELM GROVE DR
MC MURRAY PA
15317-3205
US

V. Phone/Fax

Practice location:
  • Phone: 724-941-5000
  • Fax:
Mailing address:
  • Phone: 412-719-3338
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MOLLY E LANZ
Title or Position: PEDIATRIC DENTIST
Credential: DDS
Phone: 412-719-3338