Individual
BRYCE D LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD
Contact information
Practice address
670 S GREEN VALLEY PKWY #15, HENDERSON, NV 89052
(702) 685-3700
(702) 685-3701
Mailing address
670 S GREEN VALLEY PKWY #15, HENDERSON, NV 89052
(702) 685-3700
(702) 685-3701
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
6227
NV
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
SZ-127
NV
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
55354
MN
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
D12476
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33826800
—
WI
05
—
884127000
—
MN
05
—
ENROLLED
—
MN
Enumeration date
06/11/2007
Last updated
03/19/2020
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