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General NPI Number Information
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NPI Number | 1396874863
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Entity Type | Individual
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Provider Name | JOHN WILLIAM LECLAIR D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/02/2007
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Last Update Date | 12/29/2016
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Provider Practice Location Address
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Address Line | 1315 WEST COLLEGE AVE. SUITE 201
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City | STATE COLLEGE
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State | PA
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Zip | 16801
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Country | US
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Telephone | 814-954-7620
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Fax | 814-308-9985
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Provider Business Mailing Address
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Address Line | 1315 WEST COLLEGE AVE. SUITE 201
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City | STATE COLLEGE
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State | PA
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Zip | 16801
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Country | US
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Telephone | 814-954-7620
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Fax | 814-237-3062
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DS017092L
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License Number State | PA
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