Provider Demographics
NPI:1346395209
Name:LOFSTROM, LENNART H (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LENNART
Middle Name:H
Last Name:LOFSTROM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3200 W LIBERTY RD
Mailing Address - Street 2:SUITE E
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-9746
Mailing Address - Country:US
Mailing Address - Phone:734-663-0854
Mailing Address - Fax:734-663-1374
Practice Address - Street 1:3200 W LIBERTY RD
Practice Address - Street 2:SUITE E
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-9746
Practice Address - Country:US
Practice Address - Phone:734-663-0854
Practice Address - Fax:734-663-1374
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI94351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice