Healthcare Provider Details

I. General information

NPI: 1285796409
Provider Name (Legal Business Name): FAMILY DENTAL OF MARION JAMES T LEON DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1677 MARION MT GILEAD RD SUITE 300
MARION OH
43302
US

IV. Provider business mailing address

271 BLUFF RIDGE COURT
POWELL OH
43065
US

V. Phone/Fax

Practice location:
  • Phone: 740-725-8000
  • Fax: 740-725-8020
Mailing address:
  • Phone: 614-847-0124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberOH18705
License Number StateOH

VIII. Authorized Official

Name: DR. JAMES THOMAS LEON
Title or Position: PRESIDENT
Credential:
Phone: 740-725-8000