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General NPI Number Information
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NPI Number | 1023258936
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Entity Type | Organization
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Legal Business Name | ELM DENTAL CARE, LLC
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 06/20/2012
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Provider Practice Location Address
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Address Line | 3820 ELM ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4368
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Country | US
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Telephone | 636-916-4848
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Fax | 636-916-1004
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Provider Business Mailing Address
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Address Line | 3820 ELM ST
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City | SAINT CHARLES
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State | MO
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Zip | 63301-4368
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Country | US
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Telephone | 636-916-4848
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Fax | 636-916-1004
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL R LEUCHTMANN
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Credential | D.D.S.
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Telephone | 636-916-4848
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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 | 2010021038
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License Number State | MO
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