Provider Demographics
NPI:1801203906
Name:LOTZ, JENNA (DMD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LOTZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:
Other - Last Name:PAINTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:DULCE
Mailing Address - State:NM
Mailing Address - Zip Code:87528-0187
Mailing Address - Country:US
Mailing Address - Phone:575-759-3291
Mailing Address - Fax:575-759-3651
Practice Address - Street 1:500 N MUNDO DR
Practice Address - Street 2:
Practice Address - City:DULCE
Practice Address - State:NM
Practice Address - Zip Code:87528-5176
Practice Address - Country:US
Practice Address - Phone:575-759-3291
Practice Address - Fax:575-759-3651
Is Sole Proprietor?:No
Enumeration Date:2014-07-21
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD4127122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist