Provider Demographics
NPI:1497058739
Name:ANKENY FAMILY DENTAL CENTER
Entity Type:Organization
Organization Name:ANKENY FAMILY DENTAL CENTER
Other - Org Name:LENSCH DENTAL PRACTICE, PLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DR. OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:LENSCH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:515-964-8350
Mailing Address - Street 1:2302 WEST 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-5106
Mailing Address - Country:US
Mailing Address - Phone:515-964-8350
Mailing Address - Fax:515-964-9519
Practice Address - Street 1:2302 W 1ST STREET
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-5106
Practice Address - Country:US
Practice Address - Phone:515-964-8350
Practice Address - Fax:515-964-9519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA080141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA003097Medicaid