Basic Information
| Provider Information | |||||||||
| NPI: | 1679766927 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LENTZ | ||||||||
| FirstName: | COLIN | ||||||||
| MiddleName: | PATRICK | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3635 BRASELTON HWY STE C | ||||||||
| Address2: | |||||||||
| City: | DACULA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300195932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6788021209 | ||||||||
| FaxNumber: | 6788021227 | ||||||||
| Practice Location | |||||||||
| Address1: | 1407 MAKALAPA RD | ||||||||
| Address2: | MAKALAPA NAVAL HEALTH CLINIC (DENTAL CORE) | ||||||||
| City: | PEARL HARBOR | ||||||||
| State: | HI | ||||||||
| PostalCode: | 96860 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084731880 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2007 | ||||||||
| LastUpdateDate: | 06/24/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | DN014035 | GA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 2310 | HI | Y | Dental Providers | Dentist | General Practice |
No ID Information.