Provider Demographics
NPI:1528796505
Name:LEECH, JOHN HENRY (DMD)
Entity type:Individual
Prefix:
First Name:JOHN HENRY
Middle Name:
Last Name:LEECH
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 1:47 BUSH ST
Mailing Address - Street 2:
Mailing Address - City:DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-3116
Mailing Address - Country:US
Mailing Address - Phone:610-937-5419
Mailing Address - Fax:
Practice Address - Street 1:1545 SMITH ST
Practice Address - Street 2:
Practice Address - City:NORTH PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02911-2943
Practice Address - Country:US
Practice Address - Phone:401-353-1550
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN036191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice