Healthcare Provider Details

I. General information

NPI: 1710090261
Provider Name (Legal Business Name): PETER LANZARO DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 11/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8918 VILLAGE SHOPS DR
FAIRFAX STATION VA
22039-2610
US

IV. Provider business mailing address

8918 VILLAGE SHOPS DR
FAIRFAX STATION VA
22039-2610
US

V. Phone/Fax

Practice location:
  • Phone: 703-690-0102
  • Fax: 703-690-0830
Mailing address:
  • Phone: 703-690-0102
  • Fax: 703-690-0830

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40401007298
License Number StateVA

VIII. Authorized Official

Name: DR. PETER J LANZARO
Title or Position: DENTIST
Credential:
Phone: 703-690-0102