Provider Demographics
NPI:1588969653
Name:LENTZ, BRIAN EDWARD (DMD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:EDWARD
Last Name:LENTZ
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 1:850 CHERRY ST
Mailing Address - Street 2:P.O. BOX 817
Mailing Address - City:WATERFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16441-7804
Mailing Address - Country:US
Mailing Address - Phone:814-796-2649
Mailing Address - Fax:814-796-2242
Practice Address - Street 1:850 CHERRY ST
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:PA
Practice Address - Zip Code:16441-7804
Practice Address - Country:US
Practice Address - Phone:814-796-2649
Practice Address - Fax:814-796-2242
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS029419L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice