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General NPI Number Information
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NPI Number | 1598266983
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Entity Type | Organization
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Legal Business Name | LEAF DENTAL
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Dates
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Enumeration Date | 02/22/2018
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Last Update Date | 02/22/2018
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Provider Practice Location Address
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Address Line | 5509 PLEASANT VALLEY DR STE 200
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City | PLANO
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State | TX
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Zip | 75023-5249
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Country | US
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Telephone | 916-425-4172
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Fax |
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Provider Business Mailing Address
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Address Line | 5509 PLEASANT VALLEY DR STE 200
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City | PLANO
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State | TX
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Zip | 75023-5249
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Country | US
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Telephone | 916-425-4172
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Fax |
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Authorized Official
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Title or Position | OFFICE DIRECTOR
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Name | MRS. AZITA SEDIGH
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Credential |
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Telephone | 916-425-4172
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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 |
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License Number State | TX
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