Provider Demographics
NPI:1154614147
Name:LEYDER, RONALD P JR (DDS)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:P
Last Name:LEYDER
Suffix:JR
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 1:439 LAKESHORE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTON SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:49441-3822
Mailing Address - Country:US
Mailing Address - Phone:231-750-1665
Mailing Address - Fax:
Practice Address - Street 1:837 SEMINOLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49441-6734
Practice Address - Country:US
Practice Address - Phone:231-780-4100
Practice Address - Fax:231-780-4101
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-24
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901020376122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist