Provider Demographics
NPI:1205197407
Name:LENTNER, MARK
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:LENTNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1369
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-1369
Mailing Address - Country:US
Mailing Address - Phone:304-487-3407
Mailing Address - Fax:
Practice Address - Street 1:122 12TH ST STE A
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:WV
Practice Address - Zip Code:24740-2312
Practice Address - Country:US
Practice Address - Phone:304-487-3407
Practice Address - Fax:304-487-1052
Is Sole Proprietor?:No
Enumeration Date:2012-06-04
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3120207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery