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General NPI Number Information
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NPI Number | 1013153592
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Entity Type | Organization
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Legal Business Name | D. BLAINE LEEDS DBLDDS PA
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Dates
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Enumeration Date | 01/05/2009
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Last Update Date | 01/05/2009
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Provider Practice Location Address
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Address Line | 1101 E POPLAR ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830-4420
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Country | US
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Telephone | 479-754-3357
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Fax | 479-754-0167
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Provider Business Mailing Address
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Address Line | 1101 E POPLAR ST
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City | CLARKSVILLE
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State | AR
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Zip | 72830-4420
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Country | US
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Telephone | 479-754-3357
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Fax | 479-754-0167
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Authorized Official
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Title or Position | DENTIST
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Name | MR. DANNY BLAINE LEEDS
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Credential | DDS
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Telephone | 479-754-3357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | AR3197
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License Number State | AR
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