Provider Demographics
NPI:1992160766
Name:SEBASTIAN, LEAH DITSCH
Entity type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DITSCH
Last Name:SEBASTIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:LEAH
Other - Middle Name:PERRY
Other - Last Name:DITSCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Mailing Address - Street 2:800 ROSE STREET, ROOM D104
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40536-0297
Mailing Address - Country:US
Mailing Address - Phone:859-323-9707
Mailing Address - Fax:859-257-5859
Practice Address - Street 1:UNIVERSITY OF KENTUCKY COLLEGE OF DENTISTRY
Practice Address - Street 2:800 ROSE STREET, ROOM D104
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-0297
Practice Address - Country:US
Practice Address - Phone:859-323-9707
Practice Address - Fax:859-257-5859
Is Sole Proprietor?:No
Enumeration Date:2015-12-22
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY10431223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics