# LEISURE DENTAL

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366909046
- **Authorized official:** DR. BRUCE HAGGERTY JR. DDS (OWNER/DENTIST)
- **Authorized official phone:** (214) 991-5166

## Contact information

- **Practice address:** 7870 TIDEWATER DR UNIT 202-203, NORFOLK, VA 23505-3713
- **Practice address phone:** (757) 222-3880
- **Practice address fax:** (757) 222-5137
- **Mailing address:** 4316 HILLINGDON BND APT 102, CHESAPEAKE, VA 23321-2458
- **Mailing address phone:** (214) 991-5166
- **Mailing address fax:** (757) 222-5137

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QD0000X | Dental Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 02/28/2019
- **Last updated:** 02/28/2019