Individual
DR. JACOB GRANT LEAVITT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
3326 4TH ST STE 1, LEWISTON, ID 83501-4455
(208) 746-2646
Mailing address
3326 4TH ST STE 1, LEWISTON, ID 83501-4455
(208) 746-2646
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D-5418
ID
Other
Enumeration date
06/09/2022
Last updated
06/09/2022
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