Provider Demographics
NPI:1811502057
Name:BROCK LORENZ DMD MS INC
Entity type:Organization
Organization Name:BROCK LORENZ DMD MS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BROCK
Authorized Official - Middle Name:J
Authorized Official - Last Name:LORENZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD MS
Authorized Official - Phone:619-804-8339
Mailing Address - Street 1:200 PACIFIC COAST HWY UNIT 304
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-5190
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16605 DEVONSHIRE ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6651
Practice Address - Country:US
Practice Address - Phone:818-366-4867
Practice Address - Fax:818-366-7964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty