Provider Demographics
NPI:1992325195
Name:LANTZ-SUBTELNY, BENJAMIN J (DDS)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:J
Last Name:LANTZ-SUBTELNY
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 1:411 E SENECA ST
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4407
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20 PROSPECT AVE STE 719
Practice Address - Street 2:
Practice Address - City:HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07601-1974
Practice Address - Country:US
Practice Address - Phone:551-996-5002
Practice Address - Fax:551-996-5099
Is Sole Proprietor?:No
Enumeration Date:2020-04-17
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI028019001223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery