Provider Demographics
NPI:1386604593
Name:J NICHOLAS LEYKO DDS PA
Entity type:Organization
Organization Name:J NICHOLAS LEYKO DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:NICHOLAS
Authorized Official - Last Name:LEYKO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-256-5577
Mailing Address - Street 1:4204 FORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128
Mailing Address - Country:US
Mailing Address - Phone:410-256-5577
Mailing Address - Fax:410-256-4384
Practice Address - Street 1:4204 FORGE ROAD
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128
Practice Address - Country:US
Practice Address - Phone:410-256-5577
Practice Address - Fax:410-256-4384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD40451223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty