Healthcare Provider Details

I. General information

NPI: 1952502387
Provider Name (Legal Business Name): ROGER FERDINAND LEUTZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 & ONE HALF MAIN STREET
HEBRON ND
58638
US

IV. Provider business mailing address

PO BOX 98
HEBRON ND
58638
US

V. Phone/Fax

Practice location:
  • Phone: 701-878-4700
  • Fax: 701-878-4700
Mailing address:
  • Phone: 701-878-4753
  • Fax: 701-878-4753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number1402
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: