Provider Demographics
NPI:1215964481
Name:LAWRENZ, DIETRICH ROBERT (MD DDS)
Entity type:Individual
Prefix:DR
First Name:DIETRICH
Middle Name:ROBERT
Last Name:LAWRENZ
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:290 LYTHRUM LN
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55340
Mailing Address - Country:US
Mailing Address - Phone:612-788-9246
Mailing Address - Fax:612-788-5511
Practice Address - Street 1:2519 COMMERCE DR NW STE 110
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-4433
Practice Address - Country:US
Practice Address - Phone:507-281-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11096DDS1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
U72794Medicare UPIN