Provider Demographics
NPI:1215214267
Name:BRENT E. LENZ, DDS, PC
Entity Type:Organization
Organization Name:BRENT E. LENZ, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:LENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MDS
Authorized Official - Phone:540-433-1060
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-04
Last Update Date:2011-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101631223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty