Provider Demographics
NPI:1164556924
Name:LENZ, BRENT EDWARD (DDS, MDS)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:EDWARD
Last Name:LENZ
Suffix:
Gender:M
Credentials:DDS, MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 BROOKHAVEN DR
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22801-3585
Mailing Address - Country:US
Mailing Address - Phone:540-433-1060
Mailing Address - Fax:540-433-2999
Practice Address - Street 1:1500 BROOKHAVEN DR
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-3585
Practice Address - Country:US
Practice Address - Phone:540-433-1060
Practice Address - Fax:540-433-2999
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics