Provider Demographics
NPI:1497338990
Name:LENTZ DENTAL PLLC
Entity Type:Organization
Organization Name:LENTZ DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXANDRA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:612-309-8448
Mailing Address - Street 1:102 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:MINNEOTA
Mailing Address - State:MN
Mailing Address - Zip Code:56264-9637
Mailing Address - Country:US
Mailing Address - Phone:507-872-6403
Mailing Address - Fax:507-872-6961
Practice Address - Street 1:102 E 1ST ST
Practice Address - Street 2:
Practice Address - City:MINNEOTA
Practice Address - State:MN
Practice Address - Zip Code:56264-9637
Practice Address - Country:US
Practice Address - Phone:507-872-6403
Practice Address - Fax:507-872-6961
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MND14217OtherMN STATE DENTAL LICENSE