Provider Demographics
NPI:1427827831
Name:LEISGE DENTAL, PLLC
Entity type:Organization
Organization Name:LEISGE DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CONNOR
Authorized Official - Middle Name:
Authorized Official - Last Name:LEISGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:606-733-5240
Mailing Address - Street 1:127 HIGHWAY 1084
Mailing Address - Street 2:
Mailing Address - City:BAXTER
Mailing Address - State:KY
Mailing Address - Zip Code:40806-8446
Mailing Address - Country:US
Mailing Address - Phone:606-621-0640
Mailing Address - Fax:
Practice Address - Street 1:127 HIGHWAY 1084
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:KY
Practice Address - Zip Code:40806-8446
Practice Address - Country:US
Practice Address - Phone:606-621-0640
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-27
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty