MEDICARE: LEFLEUR DENTAL GROUP

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	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1801531116
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEFLEUR DENTAL GROUP

Provider Business Mailing Address
First Line	:	4036 OAKRIDGE DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-3413
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1437 OLD SQUARE RD # STU105
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39211-5535
Country	:	US
Telephone Number	:	601-956-2000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	WILLIAM C. MAYFIELD
Credential	:	DMD
Telephone Number	:	601-291-4127

Provider Enumeration Date	:	05/02/2022
Last Update Date	:	05/02/2022

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