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General NPI Number Information
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NPI Number | 1811502057
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Entity Type | Organization
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Legal Business Name | BROCK LORENZ DMD MS INC
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Dates
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Enumeration Date | 09/14/2020
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Last Update Date | 09/14/2020
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Provider Practice Location Address
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Address Line | 16605 DEVONSHIRE ST
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City | GRANADA HILLS
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State | CA
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Zip | 91344-6651
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Country | US
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Telephone | 818-366-4867
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Fax | 818-366-7964
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Provider Business Mailing Address
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Address Line | 200 PACIFIC COAST HWY UNIT 304
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648-5190
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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 | PRESIDENT
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Name | DR. BROCK J LORENZ
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Credential | DMD MS
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Telephone | 619-804-8339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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