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General NPI Number Information
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NPI Number | 1427827831
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Entity Type | Organization
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Legal Business Name | LEISGE DENTAL, PLLC
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Dates
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Enumeration Date | 12/27/2023
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Last Update Date | 12/27/2023
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Provider Practice Location Address
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Address Line | 127 HIGHWAY 1084
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City | BAXTER
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State | KY
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Zip | 40806-8446
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Country | US
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Telephone | 606-621-0640
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Fax |
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Provider Business Mailing Address
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Address Line | 127 HIGHWAY 1084
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City | BAXTER
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State | KY
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Zip | 40806-8446
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Country | US
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Telephone | 606-621-0640
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Fax |
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Authorized Official
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Title or Position | OWNER/DENTIST
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Name | DR. CONNOR LEISGE
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Credential | DMD
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Telephone | 606-733-5240
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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 |
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License Number State |
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