Provider Demographics
NPI:1568401669
Name:LENTZ, R. DALE (DDS)
Entity Type:Individual
Prefix:
First Name:R.
Middle Name:DALE
Last Name:LENTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8140 KNUE RD
Mailing Address - Street 2:STE. 103
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-1975
Mailing Address - Country:US
Mailing Address - Phone:317-913-2363
Mailing Address - Fax:317-913-2370
Practice Address - Street 1:9240 N MERIDIAN ST
Practice Address - Street 2:STE. 300
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46260-1880
Practice Address - Country:US
Practice Address - Phone:317-846-7377
Practice Address - Fax:317-846-8566
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006398A1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN060320AMedicare ID - Type Unspecified
INT88905Medicare UPIN