=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093837676
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE JEAN LEHN DDS
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2007
-----------------------------------------------------
Last Update Date | 08/13/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10700 NORMANDALE BLVD
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55437-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-888-9661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10700 NORMANDALE BLVD
-----------------------------------------------------
City | BLOOMINGTON
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55437-2700
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 952-888-9661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | D11368
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------