MEDICARE: VAN NESS & LANZISERA, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1528150869
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VAN NESS & LANZISERA, P.C.

Provider Business Mailing Address
First Line	:	5925 LEHMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3425
Country	:	US
Telephone Number	:	719-598-6966
Fax Number	:	719-598-6964

Provider Business Practice Location Address
First Line	:	5925 LEHMAN DR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80918-3425
Country	:	US
Telephone Number	:	719-598-6966
Fax Number	:	719-598-6964

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARC R. VAN NESS
Credential	:	D.M.D.
Telephone Number	:	719-598-6966

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	08/22/2020

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