Healthcare Provider Details

I. General information

NPI: 1144901448
Provider Name (Legal Business Name): LEAP DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 07/28/2023
Certification Date: 07/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3033 SW VILLA WEST DR
TOPEKA KS
66614-4487
US

IV. Provider business mailing address

3033 SW VILLA WEST DR
TOPEKA KS
66614-4487
US

V. Phone/Fax

Practice location:
  • Phone: 785-228-0500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number
License Number State

VIII. Authorized Official

Name: DR. LOUIS LAWRENCE SPEAR
Title or Position: ORAL SURGEON
Credential:
Phone: 785-228-0500