Provider Demographics
NPI:1477089415
Name:LENZ, MARY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:LENZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:
Other - Last Name:KASTENGREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1221 N 62ND ST STE 201
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3077
Mailing Address - Country:US
Mailing Address - Phone:262-758-0706
Mailing Address - Fax:
Practice Address - Street 1:951 MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:UNION GROVE
Practice Address - State:WI
Practice Address - Zip Code:53182-1074
Practice Address - Country:US
Practice Address - Phone:262-878-2422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program