Provider Demographics
NPI:1356180186
Name:LORENZO, OLGA (DMD)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:LORENZO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 MAIN ST APT 4
Mailing Address - Street 2:
Mailing Address - City:BELLEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:07109-5203
Mailing Address - Country:US
Mailing Address - Phone:201-745-5601
Mailing Address - Fax:
Practice Address - Street 1:30 AMES AVE
Practice Address - Street 2:
Practice Address - City:RUTHERFORD
Practice Address - State:NJ
Practice Address - Zip Code:07070-1763
Practice Address - Country:US
Practice Address - Phone:201-438-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-21
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI03033400122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist