Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | D7825 | MN |
NPI | 1013022110 |
---|---|
Provider Name | Dr. Richard George Lorenz |
First Address | Litchfield, MN 55355 |
Second Address | Litchfield, MN 55355 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2006 |
Last Update Date | 08/07/2007 |