Individual
DR. BROCK JASON LORENZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.M.D., M.S.
Contact information
Practice address
4636 LEE AVE, LA MESA, CA 91942-6939
(619) 804-8339
Mailing address
4636 LEE AVE, LA MESA, CA 91942-6939
(619) 804-8339
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
61270
CA
Other
Enumeration date
05/27/2013
Last updated
07/23/2014
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