Healthcare Provider Details

I. General information

NPI: 1336709583
Provider Name (Legal Business Name): BRECK LEACH DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 2ND AVE SW
JAMESTOWN ND
58401-4104
US

IV. Provider business mailing address

102 2ND AVE SW
JAMESTOWN ND
58401-4104
US

V. Phone/Fax

Practice location:
  • Phone: 701-252-6005
  • Fax: 701-251-9188
Mailing address:
  • Phone: 701-252-6005
  • Fax: 701-251-9188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2433
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: