Provider Demographics
NPI:1942852025
Name:DELORENZO, MARC HENRY (DMD)
Entity type:Individual
Prefix:DR
First Name:MARC
Middle Name:HENRY
Last Name:DELORENZO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1036 BRIGHTON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04102-1053
Mailing Address - Country:US
Mailing Address - Phone:207-773-2150
Mailing Address - Fax:
Practice Address - Street 1:1036 BRIGHTON AVE STE A
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04102-1053
Practice Address - Country:US
Practice Address - Phone:207-773-2150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEDEN47361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice