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General NPI Number Information
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NPI Number | 1104365022
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Entity Type | Individual
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Provider Name | LAUREN LOUISE LEZA
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Gender | Female
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 11/25/2019
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Provider Practice Location Address
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Address Line | 10201 N OAK TRFY STE 300
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City | KANSAS CITY
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State | MO
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Zip | 64155-4203
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Country | US
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Telephone | 816-429-6604
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Fax | 816-429-6593
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Provider Business Mailing Address
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Address Line | 1444 GRAND BLVD APT 2220
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City | KANSAS CITY
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State | MO
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Zip | 64106-2990
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Country | US
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Telephone | 909-581-5597
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2018007141
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License Number State | MO
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