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General NPI Number Information
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NPI Number | 1043612187
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Entity Type | Organization
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Legal Business Name | JAMIE LEACH, DDS, INC.
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 450 SUTTER ST SUITE 1422
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City | SAN FRANCISCO
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State | CA
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Zip | 94108-4206
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Country | US
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Telephone | 650-353-0518
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Fax |
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Provider Business Mailing Address
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Address Line | 2551 CLAY ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-1810
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Country | US
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Telephone | 650-353-0518
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. JAMIE LEACH
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Credential | D.D.S.
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Telephone | 650-353-0518
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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 | 62686
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License Number State | CA
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