Provider Demographics
NPI:1558343541
Name:TIMOTHY J LENAGHAN DDS
Entity Type:Organization
Organization Name:TIMOTHY J LENAGHAN DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:LENAGHAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:712-482-3316
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:IA
Mailing Address - Zip Code:51560-0547
Mailing Address - Country:US
Mailing Address - Phone:712-482-3316
Mailing Address - Fax:
Practice Address - Street 1:320 OAKLAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IA
Practice Address - Zip Code:51560-4078
Practice Address - Country:US
Practice Address - Phone:712-482-3316
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161687Medicaid