Provider Demographics
NPI:1518009166
Name:LORENTZ, ROBERT P (DDS,MSPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:LORENTZ
Suffix:
Gender:M
Credentials:DDS,MSPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 N HARPER ROAD EXT
Mailing Address - Street 2:SUITE 5
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-3700
Mailing Address - Country:US
Mailing Address - Phone:662-286-3891
Mailing Address - Fax:662-286-2062
Practice Address - Street 1:1500 N HARPER ROAD EXT
Practice Address - Street 2:SUITE 5
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-3700
Practice Address - Country:US
Practice Address - Phone:662-286-3891
Practice Address - Fax:662-286-2062
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS1744761223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics