Provider Demographics
NPI:1104365022
Name:LEZA, LAUREN LOUISE
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:LOUISE
Last Name:LEZA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1444 GRAND BLVD APT 2220
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-2990
Mailing Address - Country:US
Mailing Address - Phone:909-581-5597
Mailing Address - Fax:
Practice Address - Street 1:10201 N OAK TRFY STE 300
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64155-4203
Practice Address - Country:US
Practice Address - Phone:816-429-6604
Practice Address - Fax:816-429-6593
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-13
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018007141122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist