MEDICARE: ALLISON JAE LENON

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14045503	UT

General Provider Information

NPI Number	:	1518723469
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLISON JAE LENON

Provider Business Mailing Address
First Line	:	7464 DESCHUTES CIR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89129-6028
Country	:	US
Telephone Number	:	808-203-9515
Fax Number	:

Provider Business Practice Location Address
First Line	:	3D DENTAL BN, 3RD MARINE LOGISITICS GROUP
Second Line	:	UNIT 38450
City	:	FPO
State	:	AP
Zip	:	96371
Country	:	US
Telephone Number	:	808-203-9515
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/27/2024
Last Update Date	:	08/13/2025

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