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General NPI Number Information
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NPI Number | 1659805075
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Entity Type | Individual
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Provider Name | RYAN MICHAEL LEININGER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 04/12/2017
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Provider Practice Location Address
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Address Line | 205 W HIGHWAY 95
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City | PARMA
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State | ID
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Zip | 83660-5519
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Country | US
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Telephone | 208-722-6400
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Fax |
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Provider Business Mailing Address
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Address Line | 205 W HIGHWAY 95 PO BOX 420
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City | PARMA
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State | ID
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Zip | 83660-5519
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Country | US
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Telephone | 208-722-6400
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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 | D-4779
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License Number State | ID
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