Provider Demographics
NPI:1427837996
Name:JOHN O LEITNER DDS
Entity type:Organization
Organization Name:JOHN O LEITNER DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:616-842-2850
Mailing Address - Street 1:575 ROBBINS RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417
Mailing Address - Country:US
Mailing Address - Phone:616-842-2850
Mailing Address - Fax:
Practice Address - Street 1:575 ROBBINS RD.
Practice Address - Street 2:SUITE B
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-4941
Practice Address - Country:US
Practice Address - Phone:616-842-2850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty