MEDICARE: DR. BOBBY DALE LEACH DDS

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	2838	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205831187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BOBBY DALE LEACH DDS

Provider Business Mailing Address
First Line	:	277 E RAILROAD AVE
Second Line	:	STE B
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-3407
Country	:	US
Telephone Number	:	225-791-0777
Fax Number	:	225-791-0755

Provider Business Practice Location Address
First Line	:	277 E RAILROAD AVE
Second Line	:	STE B
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70726-3407
Country	:	US
Telephone Number	:	225-791-0777
Fax Number	:	225-791-0755

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	07/08/2007

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