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NPI Code Detail

MEDICARE: DR. ALEXIS LEE LANAHAN DMD

MEDICARE: DR. ALEXIS LEE LANAHAN DMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentistDS041250PA
21223P0221XPediatric DentistryDS041250PA

General Provider Information

NPI Number : 1811424013
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALEXIS LEE LANAHAN DMD
Provider Business Mailing Address
First Line : 285 PARK PL
Second Line :
City : MEDIA
State : PA
Zip : 19063-2056
Country : US
Telephone Number : 610-739-7655
Fax Number :
Provider Business Practice Location Address
First Line : 240 GEIGER RD
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19115-1008
Country : US
Telephone Number : 215-464-2411
Fax Number : 215-827-5136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/18/2017
Last Update Date : 01/07/2026

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