Organization
LEAH C. DIVITO, DDS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LEAH CHEYANN DIVITO DDS (OWNER/DENTIST)
(234) 269-5288
Entity
Organization
Contact information
Practice address
5655 HUDSON DR STE 100, HUDSON, OH 44236-4454
(234) 269-5288
(234) 269-5289
Mailing address
5655 HUDSON DR STE 100, HUDSON, OH 44236-4454
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1699056325
PERSONAL NPI NUMBER
OH
Enumeration date
04/26/2022
Last updated
04/26/2022
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