Provider Demographics
NPI:1063437929
Name:LEIPNITZ, TODD ALERON (DDS)
Entity type:Individual
Prefix:
First Name:TODD
Middle Name:ALERON
Last Name:LEIPNITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2521 BROADWAY ST S
Mailing Address - Street 2:
Mailing Address - City:MENOMONIE
Mailing Address - State:WI
Mailing Address - Zip Code:54751-3914
Mailing Address - Country:US
Mailing Address - Phone:715-235-7371
Mailing Address - Fax:715-235-7380
Practice Address - Street 1:2521 BROADWAY ST S
Practice Address - Street 2:
Practice Address - City:MENOMONIE
Practice Address - State:WI
Practice Address - Zip Code:54751-3914
Practice Address - Country:US
Practice Address - Phone:715-235-7371
Practice Address - Fax:715-235-7380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5165-0151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33757000Medicaid