Provider Demographics
NPI:1982778429
Name:LENEXA DENTAL GROUP, CHARTERED
Entity Type:Organization
Organization Name:LENEXA DENTAL GROUP, CHARTERED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:AYER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:913-888-2733
Mailing Address - Street 1:9430 GILLETTE ST
Mailing Address - Street 2:#100
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-3766
Mailing Address - Country:US
Mailing Address - Phone:913-888-2733
Mailing Address - Fax:913-888-4224
Practice Address - Street 1:9430 GILLETTE ST
Practice Address - Street 2:#100
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-3766
Practice Address - Country:US
Practice Address - Phone:913-888-2733
Practice Address - Fax:913-888-4224
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS61041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty