MEDICARE: DAVID A LEACH DDS INC

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1538375639
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVID A LEACH DDS INC

Provider Business Mailing Address
First Line	:	7533 STATE ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-2438
Country	:	US
Telephone Number	:	513-232-6660
Fax Number	:	513-232-6670

Provider Business Practice Location Address
First Line	:	7533 STATE ROAD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45255-2438
Country	:	US
Telephone Number	:	513-232-6660
Fax Number	:	513-232-6670

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. DAVID ALAN LEACH
Credential	:	DDS
Telephone Number	:	513-232-6660

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	08/22/2020

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