Provider Demographics
NPI:1881847580
Name:LENZ, MICHAEL D (DMD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:D
Last Name:LENZ
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 1:2309 PENNSYLVANIA AVE.
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19807
Mailing Address - Country:US
Mailing Address - Phone:302-654-6915
Mailing Address - Fax:302-654-3218
Practice Address - Street 1:2309 PENNSYLVANIA AVE.
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19807
Practice Address - Country:US
Practice Address - Phone:302-654-6915
Practice Address - Fax:302-654-3218
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE12511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice