Healthcare Provider Details

I. General information

NPI: 1851549752
Provider Name (Legal Business Name): JAMES E LENAHAN, DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2008
Last Update Date: 09/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10004 KENNERLY RD SUITE 340
SAINT LOUIS MO
63128-2141
US

IV. Provider business mailing address

10004 KENNERLY RD SUITE 340
SAINT LOUIS MO
63128-2141
US

V. Phone/Fax

Practice location:
  • Phone: 314-843-8500
  • Fax: 314-842-9449
Mailing address:
  • Phone: 314-843-8500
  • Fax: 314-842-9449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number12196
License Number StateMO

VIII. Authorized Official

Name: JAMES E LENAHAN
Title or Position: PRESIDENT
Credential: DDS
Phone: 314-843-8500