Organization
LEISURE DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRUCE HAGGERTY JR. DDS (OWNER/DENTIST)
(214) 991-5166
Entity
Organization
Contact information
Practice address
7870 TIDEWATER DR UNIT 202-203, NORFOLK, VA 23505-3713
(757) 222-3880
(757) 222-5137
Mailing address
4316 HILLINGDON BND APT 102, CHESAPEAKE, VA 23321-2458
(214) 991-5166
(757) 222-5137
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
—
Other
Enumeration date
02/28/2019
Last updated
02/28/2019
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