Provider Demographics
NPI:1699938480
Name:MEAD, LEAH RASCHEL (DDS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:RASCHEL
Last Name:MEAD
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:RASCHEL
Other - Last Name:WESTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:1201 42ND ST NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-5772
Mailing Address - Country:US
Mailing Address - Phone:319-393-6152
Mailing Address - Fax:319-378-9478
Practice Address - Street 1:1201 42ND ST NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5772
Practice Address - Country:US
Practice Address - Phone:319-393-6152
Practice Address - Fax:319-378-9478
Is Sole Proprietor?:No
Enumeration Date:2008-07-02
Last Update Date:2008-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA08567122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist