Provider Demographics
NPI:1215047568
Name:FEAGAN, LONNIE T (DDS)
Entity type:Individual
Prefix:DR
First Name:LONNIE
Middle Name:T
Last Name:FEAGAN
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 1:10800 E 77 TERRACE
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64138-2331
Mailing Address - Country:US
Mailing Address - Phone:816-358-1122
Mailing Address - Fax:816-358-7853
Practice Address - Street 1:10800 E 77 TERRACE
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64138-2331
Practice Address - Country:US
Practice Address - Phone:816-358-1122
Practice Address - Fax:816-358-7853
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0120421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice