Individual
PRISCILLA M LEARY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
5721 4TH ST NW, ALBUQUERQUE, NM 87107-5302
(505) 345-0515
Mailing address
2830 TOWN CENTER DR STE 120, NEW BRAUNFELS, TX 78130-2135
(830) 730-4072
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
36824
TX
1223G0001X
General Practice Dentistry
DD5511
NM
390200000X
Student in an Organized Health Care Education/Training Program
TD-00-121
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1346875978
—
NM
05
—
1346875978
—
TX
Enumeration date
03/04/2020
Last updated
08/03/2022
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