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General NPI Number Information
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NPI Number | 1275248056
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Entity Type | Organization
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Legal Business Name | LTH DENTAL GROUP 1 PLLC
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Dates
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Enumeration Date | 01/17/2023
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Last Update Date | 01/17/2023
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Provider Practice Location Address
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Address Line | 192 W. HIGHLAND RD.
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City | HIGHLAND
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State | MI
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Zip | 48357
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Country | US
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Telephone | 586-365-9451
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Fax |
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Provider Business Mailing Address
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Address Line | 5880 STONEHAVEN BLVD
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City | ROCHESTER
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State | MI
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Zip | 48306-4941
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Country | US
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Telephone | 586-365-9451
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JUSTIN A LEATH
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Credential | DDS
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Telephone | 586-365-9451
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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 |
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License Number State |
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