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General NPI Number Information
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NPI Number | 1336709583
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Entity Type | Individual
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Provider Name | BRECK LEACH DMD
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Gender | Male
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Dates
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Enumeration Date | 06/19/2019
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Last Update Date | 06/19/2019
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Provider Practice Location Address
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Address Line | 2111 S OLD MISSOURI RD
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City | SPRINGDALE
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State | AR
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Zip | 72764-8718
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Country | US
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Telephone | 479-340-0005
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Fax |
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Provider Business Mailing Address
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Address Line | 400 RIVERWALK TER STE 250
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City | JENKS
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State | OK
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Zip | 74037-5619
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Country | US
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Telephone | 918-988-0996
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 4365
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License Number State | AR
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