Individual
BRANDON FREDERICK LEICKLY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
4939 E 82ND ST # D500, INDIANAPOLIS, IN 46250-5678
(317) 578-8900
(317) 578-8935
Mailing address
4939 E 82ND ST # D500, INDIANAPOLIS, IN 46250-5678
(317) 578-8900
(317) 578-8935
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
12012027A
IN
1223G0001X
General Practice Dentistry
Primary
D14672
MN
Other
Enumeration date
07/11/2013
Last updated
11/02/2021
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