# NATHAN D LEISKE DDS PS

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

## Provider details

- **NPI number:** 1760755342
- **Authorized official:** NATHAN D LEISKE DDS (PRESIDENT)
- **Authorized official phone:** (360) 580-0163

## Contact information

- **Practice address:** 112 S 2ND ST, SELAH, WA 98942-1308
- **Practice address phone:** (360) 580-0163
- **Mailing address:** 112 S 2ND ST, SELAH, WA 98942-1308
- **Mailing address phone:** (360) 580-0163

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 60227116 | WA | Yes |

## Other

- **Enumeration date:** 02/14/2012
- **Last updated:** 02/14/2012