Healthcare Provider Details

I. General information

NPI: 1922448745
Provider Name (Legal Business Name): MARK DAVID LENTZ D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2013
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 WESTGATE CIR STE 104
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

200 WESTGATE CIR STE 104
ANNAPOLIS MD
21401-3378
US

V. Phone/Fax

Practice location:
  • Phone: 410-268-4770
  • Fax:
Mailing address:
  • Phone: 410-268-4770
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number16688
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: