MEDICARE: DR. CAROL ANN LORENTE DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	14505	MA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	X04567	OTHER		BCBS
2	794892	OTHER		TUFTS

General Provider Information

NPI Number	:	1003898008
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CAROL ANN LORENTE DMD

Provider Business Mailing Address
First Line	:	BEDFORD VA HOSPITAL
Second Line	:	DENTAL DEPT., MAILSTOP 160, 200 SPRINGS RD.
City	:	BEDFORD
State	:	MA
Zip	:	01730
Country	:	US
Telephone Number	:	781-687-2469
Fax Number	:	781-687-3967

Provider Business Practice Location Address
First Line	:	BEDFORD VA HOSPITAL
Second Line	:	DENTAL DEPT., MAILSTOP 160, 200 SPRINGS RD.
City	:	BEDFORD
State	:	MA
Zip	:	01730
Country	:	US
Telephone Number	:	781-687-2469
Fax Number	:	781-687-3967

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/16/2005
Last Update Date	:	06/09/2022

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