Individual
DR. LEO EDWARD MORIARTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
2441 21ST ST, FORT CAMPBELL, KY 42223-5582
(270) 798-8751
(270) 956-0266
Mailing address
2441 21ST ST, FORT CAMPBELL, KY 42223-5582
(270) 798-8751
(270) 956-0266
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7424
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1065797
—
IA
Enumeration date
10/23/2006
Last updated
02/07/2020
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