Healthcare Provider Details

I. General information

NPI: 1598800658
Provider Name (Legal Business Name): HENRY DILORENZO D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 LAGRANGE AVENUE
LA PLATA MD
20646-2768
US

IV. Provider business mailing address

PO BOX 2768
LA PLATA MD
20646-2768
US

V. Phone/Fax

Practice location:
  • Phone: 301-870-3989
  • Fax: 301-870-3608
Mailing address:
  • Phone: 301-870-3989
  • Fax: 301-870-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number5339
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: