Provider Demographics
NPI:1134547474
Name:LENIUS, JEFFREY JAMES (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JAMES
Last Name:LENIUS
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 HIGHWAY K
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-8675
Mailing Address - Country:US
Mailing Address - Phone:636-978-8848
Mailing Address - Fax:636-294-4059
Practice Address - Street 1:3006 HIGHWAY K
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-8675
Practice Address - Country:US
Practice Address - Phone:636-978-8848
Practice Address - Fax:636-294-4059
Is Sole Proprietor?:No
Enumeration Date:2014-04-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS61712122300000X
IADDS-08864122300000X
MO20130439111223X0400X
KS8121223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist