Healthcare Provider Details

I. General information

NPI: 1164097069
Provider Name (Legal Business Name): LENNON COON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2021
Last Update Date: 05/24/2021
Certification Date: 05/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 32ND ST
KENNER LA
70065-3204
US

IV. Provider business mailing address

319 38TH ST
NEW ORLEANS LA
70124-1521
US

V. Phone/Fax

Practice location:
  • Phone: 504-287-4467
  • Fax:
Mailing address:
  • Phone: 318-381-0503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7179
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number7179
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: