Provider Demographics
NPI:1407959810
Name:LEHAN, CORNELIUS CHARLES (DMD)
Entity Type:Individual
Prefix:DR
First Name:CORNELIUS
Middle Name:CHARLES
Last Name:LEHAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:NEAL
Other - Middle Name:C
Other - Last Name:LEHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:959 HIGHWAY 80 EAST
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056
Mailing Address - Country:US
Mailing Address - Phone:601-925-9100
Mailing Address - Fax:601-924-1317
Practice Address - Street 1:959 HIGHWAY 80 EAST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056
Practice Address - Country:US
Practice Address - Phone:601-925-9100
Practice Address - Fax:601-924-1317
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS249389122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00660214Medicaid
883294OtherUNITED CONCORDIA