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General NPI Number Information
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NPI Number | 1124702972
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Entity Type | Individual
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Provider Name | JUSTIN LORENZO DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 02/03/2025
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Provider Practice Location Address
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Address Line | 4400 DORCHESTER RD
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City | NORTH CHARLESTON
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State | SC
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Zip | 29405-6849
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Country | US
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Telephone | 843-790-0626
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Fax |
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Provider Business Mailing Address
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Address Line | 3951 SW 140TH AVE
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City | MIAMI
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State | FL
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Zip | 33175-6457
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Country | US
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Telephone | 305-815-7899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 28114
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DGD.11015.GD
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License Number State | SC
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