Provider Demographics
NPI:1124349212
Name:LONERGAN, OWEN SHANNON (MPH, DMD, MD)
Entity type:Individual
Prefix:DR
First Name:OWEN
Middle Name:SHANNON
Last Name:LONERGAN
Suffix:
Gender:M
Credentials:MPH, DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 NE 102ND TER
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64155-7819
Mailing Address - Country:US
Mailing Address - Phone:858-354-4967
Mailing Address - Fax:
Practice Address - Street 1:638 W 39TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2910
Practice Address - Country:US
Practice Address - Phone:816-919-8895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-12
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX390200000X1223S0112X
MO2011008413122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery