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General NPI Number Information
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NPI Number | 1225175268
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Entity Type | Individual
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Provider Name | LEO J. DURRETT JR. D.D.S., P.A.
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 09/30/2011
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Provider Practice Location Address
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Address Line | 8600 15TH LANE, NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33702
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Country | US
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Telephone | 727-576-0037
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Fax | 727-576-0037
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Provider Business Mailing Address
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Address Line | 8600 15TH LANE, NORTH
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City | ST. PETERSBURG
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State | FL
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Zip | 33702
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Country | US
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Telephone | 727-576-0037
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DN6009
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License Number State | FL
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