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General NPI Number Information
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NPI Number | 1114262847
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Entity Type | Organization
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Legal Business Name | CROSS CREEK DENTAL CARE - MOUNT VERNON,LLC
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Dates
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Enumeration Date | 12/06/2012
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Last Update Date | 12/18/2012
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Provider Practice Location Address
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Address Line | 214 E CHESTNUT ST
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City | MOUNT VERNON
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State | OH
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Zip | 43050-3447
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Country | US
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Telephone | 740-725-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 214 E CHESTNUT ST
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City | MOUNT VERNON
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State | OH
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Zip | 43050-3447
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Country | US
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Telephone | 740-725-8000
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES T LEON
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Credential | DDS
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Telephone | 740-725-8000
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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 | 18705
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License Number State | OH
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