Provider Demographics
NPI:1679766927
Name:LENTZ, COLIN PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:COLIN
Middle Name:PATRICK
Last Name:LENTZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BRASELTON HWY STE C
Mailing Address - Street 2:
Mailing Address - City:DACULA
Mailing Address - State:GA
Mailing Address - Zip Code:30019-5932
Mailing Address - Country:US
Mailing Address - Phone:678-802-1209
Mailing Address - Fax:678-802-1227
Practice Address - Street 1:1407 MAKALAPA RD
Practice Address - Street 2:MAKALAPA NAVAL HEALTH CLINIC (DENTAL CORE)
Practice Address - City:PEARL HARBOR
Practice Address - State:HI
Practice Address - Zip Code:96860
Practice Address - Country:US
Practice Address - Phone:808-473-1880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-21
Last Update Date:2018-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0140351223G0001X
HI23101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice