Provider Demographics
NPI:1841410834
Name:LORENZ, ROBERT D (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:D
Last Name:LORENZ
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 1:2105 E SHIAWASSEE DR SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-5338
Mailing Address - Country:US
Mailing Address - Phone:616-243-6893
Mailing Address - Fax:
Practice Address - Street 1:4760 FULTON ST E
Practice Address - Street 2:SUITE 101
Practice Address - City:ADA
Practice Address - State:MI
Practice Address - Zip Code:49301-9097
Practice Address - Country:US
Practice Address - Phone:616-957-4560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI103441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice