Individual
GARY MICHAEL LEASE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1296 W BROAD ST, GROVELAND, FL 34736-2012
(407) 905-8827
(352) 429-1257
Mailing address
PO BOX 1249, APOPKA, FL 32704-1249
(407) 905-8827
(407) 905-8998
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN13231
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
071836000
—
FL
Enumeration date
07/11/2005
Last updated
08/18/2011
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