MEDICARE: DR. THERALD LUND LEONARD 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	3830	WA

General Provider Information

NPI Number	:	1497843510
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THERALD LUND LEONARD D.D.S

Provider Business Mailing Address
First Line	:	15321 SE 344TH ST
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98092-3959
Country	:	US
Telephone Number	:	253-939-3326
Fax Number	:

Provider Business Practice Location Address
First Line	:	1268 E MAIN ST
Second Line	:
City	:	AUBURN
State	:	WA
Zip	:	98002-5748
Country	:	US
Telephone Number	:	253-939-2444
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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