Healthcare Provider Details

I. General information

NPI: 1619093556
Provider Name (Legal Business Name): BRENT E LENZ DDS MDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2870D S MAIN ST
HARRISONBURG VA
22801-2664
US

IV. Provider business mailing address

2870D S MAIN ST
HARRISONBURG VA
22801-2664
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: DDS, MDS
Phone: 540-433-1060