Provider Demographics
NPI:1588381727
Name:ERIC S. LEITHNER, DMD, PC
Entity type:Organization
Organization Name:ERIC S. LEITHNER, DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/DENTIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:LEITHNER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-855-2904
Mailing Address - Street 1:107 VALLEY RUN DR.
Mailing Address - Street 2:
Mailing Address - City:BREMEN
Mailing Address - State:GA
Mailing Address - Zip Code:30110
Mailing Address - Country:US
Mailing Address - Phone:770-537-9656
Mailing Address - Fax:
Practice Address - Street 1:107 VALLEY RUN DR.
Practice Address - Street 2:
Practice Address - City:BREMEN
Practice Address - State:GA
Practice Address - Zip Code:30110
Practice Address - Country:US
Practice Address - Phone:770-537-9656
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ERIC S. LEITHNER, DMD, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty