Provider Demographics
NPI:1205088135
Name:LORENTZ, KALLI ANN (RDH)
Entity type:Individual
Prefix:
First Name:KALLI
Middle Name:ANN
Last Name:LORENTZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 BUCKSKIN AVE W
Mailing Address - Street 2:
Mailing Address - City:PILLAGER
Mailing Address - State:MN
Mailing Address - Zip Code:56473-2509
Mailing Address - Country:US
Mailing Address - Phone:218-746-4555
Mailing Address - Fax:
Practice Address - Street 1:727 BUCKSKIN AVE W
Practice Address - Street 2:
Practice Address - City:PILLAGER
Practice Address - State:MN
Practice Address - Zip Code:56473-2509
Practice Address - Country:US
Practice Address - Phone:218-746-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNH7192124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist