Provider Demographics
NPI:1457810012
Name:LEISHMAN, TIMOTHY (DMD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:LEISHMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 690925
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77269-0925
Mailing Address - Country:US
Mailing Address - Phone:214-399-5839
Mailing Address - Fax:
Practice Address - Street 1:12924 WILLOW CHASE DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5641
Practice Address - Country:US
Practice Address - Phone:832-905-9394
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX381201223G0001X, 1223D0004X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDental Anesthesiology
No1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program