Paul C Lanzer, DDS
Individual provider Active NPI General Practice Dentistry · Bloomer, WI
NPI 1891870960 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1891870960
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- WI5001523 (WI)
- Practice address
- 1604 Main St
Bloomer, WI 54724-1647 - Phone
- (715) 568-1012
- Fax
- (715) 568-1010
- NPI assigned
- Oct 26, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| WI5001523 | WI | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | WI5001523 | WI | Yes |
Addresses
Primary practice location
1604 Main St
Bloomer, WI 54724-1647
Mailing address
PO Box 67
Bloomer, WI 54724-0067
Phone (715) 568-1012
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 33656000 | Medicaid | WI |
Other providers in Bloomer, WI
- Jaclyn Kay Kron
- Mary J Kuehl
- Deborah Lynne Labudde
- Robin Lachance
- Susan Langert
- John Larson
- Carmella Leggon
- Sandra Sue Leuthe
- Keith Allen Levick
- Robin A Lohse
All providers in Bloomer, WI · General Practice Dentistry in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.