Healthcare Provider Details

I. General information

NPI: 1215214267
Provider Name (Legal Business Name): BRENT E. LENZ, DDS, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
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: DR. BRENT EDWARD LENZ
Title or Position: OWNER
Credential: D.D.S., M.D.S.
Phone: 540-433-1060