Provider Demographics
NPI:1679793400
Name:LENZ, JOHN J (DDS)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:LENZ
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 1:2309 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1318
Mailing Address - Country:US
Mailing Address - Phone:302-654-6915
Mailing Address - Fax:302-654-3218
Practice Address - Street 1:2309 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-1318
Practice Address - Country:US
Practice Address - Phone:302-654-6915
Practice Address - Fax:302-654-3218
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG1-00008081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice