Provider Demographics
NPI:1306295514
Name:LENZI, LAURA J (60521601)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:J
Last Name:LENZI
Suffix:
Gender:F
Credentials:60521601
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 34703
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-1703
Mailing Address - Country:US
Mailing Address - Phone:206-226-5672
Mailing Address - Fax:
Practice Address - Street 1:2781 S 242ND ST
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-5166
Practice Address - Country:US
Practice Address - Phone:206-226-5672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60521601124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA152842010OtherHYGIENE DENTAL