Provider Demographics
NPI:1215501622
Name:MARCIL, LORENZO DANIEL (DMD)
Entity type:Individual
Prefix:DR
First Name:LORENZO
Middle Name:DANIEL
Last Name:MARCIL
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 1:80 EDGEVALLEY PL NW
Mailing Address - Street 2:
Mailing Address - City:CALGARY
Mailing Address - State:ALBERTA
Mailing Address - Zip Code:T3A 4Z1
Mailing Address - Country:CA
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:259 YALE AVE N
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109-5430
Practice Address - Country:US
Practice Address - Phone:206-829-8565
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-19
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
WADR61192695122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program