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NPI Code Detail

MEDICARE: DR. JASON ALLAN LEACH D.M.D.

MEDICARE: DR. JASON ALLAN LEACH D.M.D.
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
1122300000XDentistD6188AZ

General Provider Information

NPI Number : 1962543876
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JASON ALLAN LEACH D.M.D.
Provider Business Mailing Address
First Line : 8151 E INDIAN BEND RD
Second Line : STE 111
City : SCOTTSDALE
State : AZ
Zip : 85250-4826
Country : US
Telephone Number : 480-607-9999
Fax Number :
Provider Business Practice Location Address
First Line : 2154 GOODMAN RD W
Second Line :
City : HORN LAKE
State : MS
Zip : 38637-1303
Country : US
Telephone Number : 662-393-9200
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/12/2007
Last Update Date : 12/23/2015

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