Provider Demographics
NPI:1659114049
Name:LORENC, LYDIA A (DMD)
Entity type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:A
Last Name:LORENC
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 1:16881 LONDONBERRY LN
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1444
Mailing Address - Country:US
Mailing Address - Phone:224-383-4483
Mailing Address - Fax:
Practice Address - Street 1:17455 DOUGLAS RD
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46635-1732
Practice Address - Country:US
Practice Address - Phone:574-243-5584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12014494A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice