MEDICARE: MACAIRA LEAHY

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	1223P0221X	Pediatric Dentistry	DEN.00205523	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	09548	OTHER	IA	STATE LICENSE
2	DEN.00205523	OTHER	CO	STATE LICENSE

General Provider Information

NPI Number	:	1720565344
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MACAIRA LEAHY

Provider Business Mailing Address
First Line	:	1576 MAIN ST
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-7909
Country	:	US
Telephone Number	:	319-335-7440
Fax Number	:	193-335-7451

Provider Business Practice Location Address
First Line	:	1576 MAIN ST
Second Line	:
City	:	WINDSOR
State	:	CO
Zip	:	80550-7909
Country	:	US
Telephone Number	:	319-335-7440
Fax Number	:

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

Provider Enumeration Date	:	07/26/2018
Last Update Date	:	09/19/2023

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Directions to “ MACAIRA LEAHY ” Practice Location

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