Healthcare Provider Details

I. General information

NPI: 1164556924
Provider Name (Legal Business Name): BRENT EDWARD LENZ D.D.S., M.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 10/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 BROOKHAVEN DR
HARRISONBURG VA
22801-3585
US

IV. Provider business mailing address

1500 BROOKHAVEN DR
HARRISONBURG VA
22801-3585
US

V. Phone/Fax

Practice location:
  • Phone: 540-433-1060
  • Fax: 540-433-2999
Mailing address:
  • Phone: 540-433-1060
  • Fax: 540-433-2999

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number0401410163
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: