Provider Demographics
NPI:1265651129
Name:LOZENICH, GARY A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:A
Last Name:LOZENICH
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 1:4045 W 13 MILE RD STE B5
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6640
Mailing Address - Country:US
Mailing Address - Phone:248-280-4500
Mailing Address - Fax:248-280-4502
Practice Address - Street 1:4045 W 13 MILE RD STE B5
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6640
Practice Address - Country:US
Practice Address - Phone:248-280-4500
Practice Address - Fax:248-280-4502
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI015660122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist