Provider Demographics
NPI:1285009506
Name:LENHAUSEN, ADELLE (RDH)
Entity Type:Individual
Prefix:
First Name:ADELLE
Middle Name:
Last Name:LENHAUSEN
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36500 FRONT ST
Mailing Address - Street 2:
Mailing Address - City:NEW BALTIMORE
Mailing Address - State:MI
Mailing Address - Zip Code:48047-2549
Mailing Address - Country:US
Mailing Address - Phone:586-713-8848
Mailing Address - Fax:
Practice Address - Street 1:36500 FRONT ST
Practice Address - Street 2:
Practice Address - City:NEW BALTIMORE
Practice Address - State:MI
Practice Address - Zip Code:48047
Practice Address - Country:US
Practice Address - Phone:586-713-8848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-11
Last Update Date:2015-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902017701124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist