Individual
DR. JONATHAN BLAKE LEIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1138 ROSE HILL DR STE 400, CHARLOTTESVILLE, VA 22903-5128
(434) 972-6233
Mailing address
2359 WHEATLANDS DR, MANAKIN SABOT, VA 23103-2134
(757) 812-2309
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
0401415730
VA
Other
Enumeration date
09/06/2017
Last updated
11/16/2022
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