Individual
DR. WALTER L LEEKS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
4376 LAWRENCEVILLE RD, LOGANVILLE, GA 30052
(770) 466-0363
Mailing address
4376 LAWRENCEVILLE RD, LOGANVILLE, GA 30052
(770) 466-0363
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DN 13122
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
19029327
—
IL
Enumeration date
05/22/2007
Last updated
12/13/2016
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