Provider Demographics
NPI:1447360441
Name:LANZARO, PETER J (DDS)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:J
Last Name:LANZARO
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 1:5012 WAPLE LN
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-7738
Mailing Address - Country:US
Mailing Address - Phone:703-966-8976
Mailing Address - Fax:703-690-0830
Practice Address - Street 1:5012 WAPLE LN
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-7738
Practice Address - Country:US
Practice Address - Phone:703-966-8976
Practice Address - Fax:703-690-0830
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010072981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice