MEDICARE: HANNAH LEEZER DDS, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1093695199
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HANNAH LEEZER DDS, LLC

Provider Business Mailing Address
First Line	:	1515 STARCROSS LN APT 105
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46280-3018
Country	:	US
Telephone Number	:	317-213-7439
Fax Number	:

Provider Business Practice Location Address
First Line	:	4715 STATESMEN DR STE G
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-1997
Country	:	US
Telephone Number	:	317-213-7439
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. HANNAH ELIZABETH GROH
Credential	:	DDS
Telephone Number	:	317-213-7439

Provider Enumeration Date	:	09/08/2025
Last Update Date	:	09/08/2025

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