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General NPI Number Information
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NPI Number | 1013681584
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Entity Type | Organization
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Legal Business Name | BRECK LEACH DMD, PLLC
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 06/24/2024
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Provider Practice Location Address
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Address Line | 102 2ND AVE SW
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City | JAMESTOWN
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State | ND
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Zip | 58401-4104
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Country | US
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Telephone | 701-252-6005
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Fax | 701-251-9188
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Provider Business Mailing Address
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Address Line | 1209 5TH AVE SE STE 6
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City | JAMESTOWN
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State | ND
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Zip | 58401-5601
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Country | US
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Telephone | 701-252-6005
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Fax | 701-251-9188
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRECK ANDREW LEACH
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Credential | DMD
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Telephone | 701-252-6005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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