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General NPI Number Information
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NPI Number | 1295922946
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Entity Type | Organization
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Legal Business Name | LEIPNITZ DENTAL CLINIC, SC
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Dates
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Enumeration Date | 09/26/2007
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Last Update Date | 09/26/2007
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Provider Practice Location Address
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Address Line | 2521 BROADWAY ST S
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City | MENOMONIE
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State | WI
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Zip | 54751-3914
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Country | US
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Telephone | 715-235-7371
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Fax | 715-235-7380
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Provider Business Mailing Address
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Address Line | 2521 BROADWAY ST S
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City | MENOMONIE
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State | WI
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Zip | 54751-3914
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Country | US
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Telephone | 715-235-7371
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Fax | 715-235-7380
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. TODD ALERON LEIPNITZ
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Credential | D.D.S.
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Telephone | 715-235-7371
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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 | 5165-015
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License Number State | WI
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