Provider Demographics
NPI:1548514763
Name:LENAGHAN, TIMOTHY J
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:LENAGHAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. 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:712-482-3316
Practice Address - Street 1:406 S. DR. VAN ZEE RD.
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:IA
Practice Address - Zip Code:51560-0547
Practice Address - Country:US
Practice Address - Phone:712-482-3316
Practice Address - Fax:712-482-3316
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA06448122300000X
NE5398122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161687Medicaid