Provider Demographics
NPI:1306912407
Name:UICKER, LEO WILLIAM (DDS)
Entity type:Individual
Prefix:DR
First Name:LEO
Middle Name:WILLIAM
Last Name:UICKER
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 1:7907 PROVIDENCE RD
Mailing Address - Street 2:SUITE 250
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28277-9721
Mailing Address - Country:US
Mailing Address - Phone:704-540-1212
Mailing Address - Fax:704-540-1610
Practice Address - Street 1:7907 PROVIDENCE RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28277-9721
Practice Address - Country:US
Practice Address - Phone:704-540-1212
Practice Address - Fax:704-540-1610
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC52461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC98699OtherBLUECROSSBLUESHIELD OF NC