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General NPI Number Information
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NPI Number | 1588790307
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Entity Type | Individual
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Provider Name | RICHARD D LEATHERS DDS
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12021 WILMINGTON AVE
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City | LOS ANGELES
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State | CA
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Zip | 90059-3019
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Country | US
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Telephone | 310-668-4515
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Fax | 310-763-8909
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Provider Business Mailing Address
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Address Line | 4054 ATHENIAN WAY
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City | LOS ANGELES
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State | CA
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Zip | 90043-1618
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Country | US
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Telephone |
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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 | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number | DK28026
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License Number State | CA
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