=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669863247
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | JOHN A LEPPARD DMD,PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2015
-----------------------------------------------------
Last Update Date | 02/18/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1285 WILKESBORO BLVD
-----------------------------------------------------
City | LENOIR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28645-4728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-263-3517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1559
-----------------------------------------------------
City | LENOIR
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28645-1559
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 828-263-3517
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JOHN ALEXANDER LEPPARD SR.
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 828-295-6293
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 7704
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------