MEDICARE: DR. DIANNA LYNN LENICK DDS

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	2745	WV
2	1223G0001X	General Practice Dentistry	4160	SC

General Provider Information

NPI Number	:	1700922887
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DIANNA LYNN LENICK DDS

Provider Business Mailing Address
First Line	:	21 NEW ORLEANS RD STE A
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4797
Country	:	US
Telephone Number	:	843-785-6285
Fax Number	:	304-344-9302

Provider Business Practice Location Address
First Line	:	21 NEW ORLEANS RD
Second Line	:
City	:	HILTON HEAD ISLAND
State	:	SC
Zip	:	29928-4732
Country	:	US
Telephone Number	:	843-785-6285
Fax Number	:

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

Provider Enumeration Date	:	01/29/2007
Last Update Date	:	02/05/2025

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