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General NPI Number Information
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NPI Number | 1124349212
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Entity Type | Individual
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Provider Name | OWEN SHANNON LONERGAN MPH, DMD, MD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2010
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 638 W 39TH ST
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City | KANSAS CITY
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State | MO
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Zip | 64111-2910
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Country | US
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Telephone | 816-919-8895
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 NE 102ND TER
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City | KANSAS CITY
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State | MO
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Zip | 64155-7819
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Country | US
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Telephone | 858-354-4967
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 62200
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 390200000X
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 2011008413
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License Number State | MO
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