Provider Demographics
NPI:1144316159
Name:LANZA, SALVATORE (DDS)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:
Last Name:LANZA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4066 AMBOY RD
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10308-2409
Mailing Address - Country:US
Mailing Address - Phone:718-967-2282
Mailing Address - Fax:718-967-2281
Practice Address - Street 1:4066 AMBOY RD
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10308-2409
Practice Address - Country:US
Practice Address - Phone:718-972-2282
Practice Address - Fax:718-972-2281
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D102200600122300000X
NY0488541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist