Healthcare Provider Details

I. General information

NPI: 1124349212
Provider Name (Legal Business Name): OWEN SHANNON LONERGAN MPH, DMD, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2010
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

638 W 39TH ST
KANSAS CITY MO
64111-2910
US

IV. Provider business mailing address

3210 NE 102ND TER
KANSAS CITY MO
64155-7819
US

V. Phone/Fax

Practice location:
  • Phone: 816-919-8895
  • Fax:
Mailing address:
  • Phone: 858-354-4967
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number62200
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number390200000X
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2011008413
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: