MEDICARE: DR. BOBBY DON LEACH D.D.S.

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	8450	TX

General Provider Information

NPI Number	:	1184780264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY DON LEACH D.D.S.

Provider Business Mailing Address
First Line	:	2359 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3004
Country	:	US
Telephone Number	:	214-321-3434
Fax Number	:	972-516-3290

Provider Business Practice Location Address
First Line	:	2359 GUS THOMASSON RD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75228-3004
Country	:	US
Telephone Number	:	214-321-3434
Fax Number	:	972-516-3290

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2006
Last Update Date	:	07/08/2007

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