Healthcare Provider Details

I. General information

NPI: 1275993859
Provider Name (Legal Business Name): ROBERT A LANTZY DMD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2016
Last Update Date: 02/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 FRIENDS LN STE 100
NEWTOWN PA
18940-1885
US

IV. Provider business mailing address

11 FRIENDS LN STE 100
NEWTOWN PA
18940-1885
US

V. Phone/Fax

Practice location:
  • Phone: 215-860-5901
  • Fax: 215-860-9467
Mailing address:
  • Phone: 215-860-5901
  • Fax: 215-860-9467

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS022966L
License Number StatePA

VII. Legacy identifiers

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

VIII. Authorized Official

Name: DR. ROBERT A LANTZY
Title or Position: OWNER
Credential: DMD
Phone: 215-860-5901