Provider Demographics
NPI:1306928627
Name:LAUCKHARDT-WEEAST, LEAH (RDH)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:
Last Name:LAUCKHARDT-WEEAST
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 WOODEN AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PLAINFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07080-3950
Mailing Address - Country:US
Mailing Address - Phone:908-753-6804
Mailing Address - Fax:
Practice Address - Street 1:4 PROGRESS ST
Practice Address - Street 2:SUITE B-1
Practice Address - City:EDISON
Practice Address - State:NJ
Practice Address - Zip Code:08820-1199
Practice Address - Country:US
Practice Address - Phone:908-757-3191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22HI00775700124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist