Healthcare Provider Details

I. General information

NPI: 1497429906
Provider Name (Legal Business Name): MELANIE LYNN LORENZ DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 08/07/2021
Certification Date: 08/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SANDY BOTTOM RD
COVENTRY RI
02816-5865
US

IV. Provider business mailing address

1375 CENTER ST
DIGHTON MA
02715-1129
US

V. Phone/Fax

Practice location:
  • Phone: 401-822-3352
  • Fax:
Mailing address:
  • Phone: 774-488-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDEN03564
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: