Provider Demographics
NPI:1487739900
Name:LENTZ, ASHLEY K (MD)
Entity type:Individual
Prefix:DR
First Name:ASHLEY
Middle Name:K
Last Name:LENTZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:K
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1265 W GRANADA BLVD
Mailing Address - Street 2:STE 3
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-8256
Mailing Address - Country:US
Mailing Address - Phone:386-252-8051
Mailing Address - Fax:386-252-1173
Practice Address - Street 1:1265 WEST GRANADA BOULEVARD
Practice Address - Street 2:SUITE 3
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-252-8051
Practice Address - Fax:386-252-1173
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME91557208200000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002490200Medicaid
FL002490200Medicaid