Provider Demographics
NPI:1992031314
Name:LENOX, SIDNEY DARRYL (DDS)
Entity Type:Individual
Prefix:DR
First Name:SIDNEY
Middle Name:DARRYL
Last Name:LENOX
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 1:2707 E 21ST ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-2249
Mailing Address - Country:US
Mailing Address - Phone:316-691-0249
Mailing Address - Fax:316-691-9939
Practice Address - Street 1:2707 E 21ST ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67214
Practice Address - Country:US
Practice Address - Phone:316-691-0249
Practice Address - Fax:316-691-9939
Is Sole Proprietor?:No
Enumeration Date:2009-10-19
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60728122300000X
VA0401412627122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist