Healthcare Provider Details

I. General information

NPI: 1942953021
Provider Name (Legal Business Name): LAUREL GRACE LEAVITT DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2022
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 E AURORA RD
MACEDONIA OH
44056-1837
US

IV. Provider business mailing address

545 E AURORA RD
MACEDONIA OH
44056-1837
US

V. Phone/Fax

Practice location:
  • Phone: 330-331-0125
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number30.027318
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: