Provider Demographics
NPI:1194358556
Name:LANZI, COURTNEY LOMBARDO
Entity type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:LOMBARDO
Last Name:LANZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 SE FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7850
Mailing Address - Country:US
Mailing Address - Phone:772-888-1995
Mailing Address - Fax:
Practice Address - Street 1:5920 SE FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-7850
Practice Address - Country:US
Practice Address - Phone:772-888-1995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2024-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL242191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
24219OtherLICENSE