Individual
BRYCE D LEAVITT
Active
Individual
BRYCE D LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD, MD
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
Update your record
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