Provider Demographics
NPI:1518253970
Name:LENTZ, BRAD ALLEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRAD
Middle Name:ALLEN
Last Name:LENTZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1170 LEJACK CIR
Mailing Address - Street 2:
Mailing Address - City:FOREST
Mailing Address - State:VA
Mailing Address - Zip Code:24551-1263
Mailing Address - Country:US
Mailing Address - Phone:814-659-8236
Mailing Address - Fax:
Practice Address - Street 1:3719 OLD FOREST RD
Practice Address - Street 2:
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24501-6903
Practice Address - Country:US
Practice Address - Phone:434-384-7611
Practice Address - Fax:434-384-5656
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-23
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401414469122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist