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NPI Code Detail

MEDICARE: DR. GUY LEAVITT DDS

MEDICARE: DR. GUY LEAVITT 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
11223G0001XGeneral Practice DentistryTP60171118WA

General Provider Information

NPI Number : 1790911527
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GUY LEAVITT DDS
Provider Business Mailing Address
First Line : 4309 W NOB HILL BLVD
Second Line :
City : YAKIMA
State : WA
Zip : 98908-3971
Country : US
Telephone Number : 509-823-4480
Fax Number : 509-823-4488
Provider Business Practice Location Address
First Line : 4309 W NOB HILL BLVD
Second Line :
City : YAKIMA
State : WA
Zip : 98908-3971
Country : US
Telephone Number : 509-823-4480
Fax Number : 509-823-4488
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/08/2009
Last Update Date : 07/07/2010

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Directions to “ DR. GUY LEAVITT DDS” Practice Location

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