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General NPI Number Information
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NPI Number | 1720166275
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Entity Type | Individual
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Provider Name | MICHAEL DE LORENZO DMD
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Gender | Male
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Dates
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Enumeration Date | 11/01/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 169 UNION BLVD 2-F
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City | TOTOWA
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State | NJ
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Zip | 07512-2603
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Country | US
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Telephone | 201-787-8549
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Fax |
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Provider Business Mailing Address
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Address Line | 81 ELCOCK AVE
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City | BOONTON
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State | NJ
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Zip | 07005-1100
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Country | US
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Telephone |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 22DI 01595300
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License Number State | NJ
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