Healthcare Provider Details

I. General information

NPI: 1447241203
Provider Name (Legal Business Name): JASON STUART LENK DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/02/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5210 BOX 230
APO AE
09461
GB

IV. Provider business mailing address

PSC 41 BOX 3891
APO AE
09464
GB

V. Phone/Fax

Practice location:
  • Phone: 163-852-8124
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number3061
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: