Healthcare Provider Details

I. General information

NPI: 1851474902
Provider Name (Legal Business Name): LAWRENCE P. LORENZI D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74303 HIGHWAY 111 STE 2A
PALM DESERT CA
92260-4141
US

IV. Provider business mailing address

1812 PORT MARGATE PL
NEWPORT BEACH CA
92660-5324
US

V. Phone/Fax

Practice location:
  • Phone: 949-945-4274
  • Fax:
Mailing address:
  • Phone: 949-500-0018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0106X
TaxonomyOral and Maxillofacial Pathology Dentistry
License Number25937
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: