Provider Demographics
NPI:1932221157
Name:LUTZ, EDWARD GRANT (DDS)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:GRANT
Last Name:LUTZ
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 1:8940 GARLAND RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75218-3917
Mailing Address - Country:US
Mailing Address - Phone:214-321-9191
Mailing Address - Fax:214-321-9299
Practice Address - Street 1:8940 GARLAND RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75218-3917
Practice Address - Country:US
Practice Address - Phone:214-321-9191
Practice Address - Fax:214-321-9299
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice