Individual
DR. CONNOR FRANKLIN LEISGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
127 HIGHWAY 1084, BAXTER, KY 40806-8446
(606) 733-5240
Mailing address
207 WOODLAND HLS, HARLAN, KY 40831-2563
(606) 733-5240
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10815
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10815
KENTUCKY BOARD OF DENTISTRY
KY
05
—
7100894290
—
KY
Enumeration date
04/10/2022
Last updated
09/18/2023
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