Healthcare Provider Details

I. General information

NPI: 1679665178
Provider Name (Legal Business Name): IAN PAUL LENNARD DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6501 CROWN BLVD SUITE 204
SAN JOSE CA
95120-2903
US

IV. Provider business mailing address

6501 CROWN BLVD SUITE 204
SAN JOSE CA
95120-2903
US

V. Phone/Fax

Practice location:
  • Phone: 408-268-4433
  • Fax: 408-268-4533
Mailing address:
  • Phone: 408-268-4433
  • Fax: 408-268-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number42930
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: