Healthcare Provider Details

I. General information

NPI: 1770572752
Provider Name (Legal Business Name): LEON ANTHONY NIEH D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2005
Last Update Date: 09/22/2024
Certification Date: 09/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5134 BOX 10
APO AP
96368-5134
US

IV. Provider business mailing address

UNIT 5134 BOX 10
APO AP
96368-5134
US

V. Phone/Fax

Practice location:
  • Phone: 315-630-4383
  • Fax:
Mailing address:
  • Phone: 315-630-4383
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE00009210
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: