Provider Demographics
NPI:1588726822
Name:VAZZANA, LORENZO STEPHEN (DDS)
Entity type:Individual
Prefix:MR
First Name:LORENZO
Middle Name:STEPHEN
Last Name:VAZZANA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:LAWRENCE
Other - Middle Name:S
Other - Last Name:VAZZANA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:11295 KERRICK CT
Mailing Address - Street 2:
Mailing Address - City:LA PLATA
Mailing Address - State:MD
Mailing Address - Zip Code:20646-3323
Mailing Address - Country:US
Mailing Address - Phone:301-932-6805
Mailing Address - Fax:301-932-6805
Practice Address - Street 1:2955 CRAIN HWY
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2810
Practice Address - Country:US
Practice Address - Phone:301-843-9330
Practice Address - Fax:301-645-4654
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD43871223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics