MEDICARE: MICHAEL L. LEINGANG, III, DDS, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	012285	GA

General Provider Information

NPI Number	:	1154530293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL L. LEINGANG, III, DDS, PC

Provider Business Mailing Address
First Line	:	3823 ROSWELL RD
Second Line	:	SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30062-6278
Country	:	US
Telephone Number	:	770-977-1892
Fax Number	:	678-560-5261

Provider Business Practice Location Address
First Line	:	3823 ROSWELL RD
Second Line	:	SUITE 201
City	:	MARIETTA
State	:	GA
Zip	:	30062-6278
Country	:	US
Telephone Number	:	770-977-1892
Fax Number	:	678-560-5261

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MICHAEL LOUIS LEINGANG III
Credential	:	D.D.S.
Telephone Number	:	770-977-1892

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	08/22/2020

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