Healthcare Provider Details

I. General information

NPI: 1215501622
Provider Name (Legal Business Name): LORENZO DANIEL MARCIL DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2021
Last Update Date: 10/10/2023
Certification Date: 10/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

259 YALE AVE N
SEATTLE WA
98109-5430
US

IV. Provider business mailing address

80 EDGEVALLEY PL NW
CALGARY ALBERTA
T3A 4Z1
CA

V. Phone/Fax

Practice location:
  • Phone: 206-829-8565
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDR61192695
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: