Provider Demographics
NPI:1568687531
Name:BRIAN E LENTZ DMD PC
Entity Type:Organization
Organization Name:BRIAN E LENTZ DMD PC
Other - Org Name:HENRY R LENTZ DMD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:LENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:814-796-2649
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:850 CHERRY STREET
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-0817
Mailing Address - Country:US
Mailing Address - Phone:814-796-2649
Mailing Address - Fax:814-796-2242
Practice Address - Street 1:850 CHERRY STREET
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-0817
Practice Address - Country:US
Practice Address - Phone:814-796-2649
Practice Address - Fax:814-796-2242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029419L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty