Provider Demographics
NPI:1245606268
Name:KINZER, LORI JO (RDH)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:JO
Last Name:KINZER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6665 DELMONICO DRIVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919
Mailing Address - Country:US
Mailing Address - Phone:719-599-5700
Mailing Address - Fax:719-260-5685
Practice Address - Street 1:6665 DELMONICO DR
Practice Address - Street 2:SUITE C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80919
Practice Address - Country:US
Practice Address - Phone:719-599-5700
Practice Address - Fax:719-260-5685
Is Sole Proprietor?:No
Enumeration Date:2015-08-13
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODH.000902947124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist