Provider Demographics
NPI:1699056325
Name:DIVITO, LEAH CHEYANN (DDS)
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:CHEYANN
Last Name:DIVITO
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6323 TUSSING RD
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-3984
Mailing Address - Country:US
Mailing Address - Phone:614-863-2222
Mailing Address - Fax:
Practice Address - Street 1:6323 TUSSING RD
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-3984
Practice Address - Country:US
Practice Address - Phone:614-863-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2012-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-023728122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist