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Organization
LEAVITT FAMILY AND COSMETIC DENTISTRY
Active
Organization
LEAVITT FAMILY AND COSMETIC DENTISTRY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CASEY J. LEAVITT DDS PA (DR)
(208) 233-6900
Entity
Organization
Contact information
Practice address
333 W CEDAR ST, POCATELLO, ID 83201
(208) 233-6900
Mailing address
333 W CEDAR ST, POCATELLO, ID 83201-5045
(208) 233-6900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1531413
UNITED CONCORDIA
ID
Enumeration date
06/09/2008
Last updated
06/25/2008
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