Provider Demographics
NPI:1447348180
Name:LORSCHEIDER, MICHAEL H (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:H
Last Name:LORSCHEIDER
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 1:2476 N UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-3868
Mailing Address - Country:US
Mailing Address - Phone:801-377-0990
Mailing Address - Fax:801-373-3361
Practice Address - Street 1:2476 N UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:PROVO
Practice Address - State:UT
Practice Address - Zip Code:84604-3868
Practice Address - Country:US
Practice Address - Phone:801-377-0990
Practice Address - Fax:801-373-3361
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2015-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UTUT 24121223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT044568OtherMEDICAID DELTA DENTAL