Individual
THOMAS R LEACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
11990 JACKSON ST, CLINTON, LA 70722-3210
(225) 683-5292
Mailing address
P.O.BOX 395, CLINTON, LA 70722
(225) 395-8022
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
6240
LA
1223G0001X
General Practice Dentistry
Primary
043194
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1862401
—
LA
Enumeration date
08/18/2005
Last updated
03/29/2019
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