Provider Demographics
NPI:1508067836
Name:LERNER, DOUGLAS H (DDS)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:H
Last Name:LERNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 E MAIN ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1313
Mailing Address - Country:US
Mailing Address - Phone:913-856-8721
Mailing Address - Fax:913-884-2530
Practice Address - Street 1:325 E MAIN ST
Practice Address - Street 2:SUITE A
Practice Address - City:GARDNER
Practice Address - State:KS
Practice Address - Zip Code:66030-1313
Practice Address - Country:US
Practice Address - Phone:913-856-8721
Practice Address - Fax:913-884-2530
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008012647122300000X
KS604831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist