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Individual

TRACY MARIE LEICHTENBERGER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
RDH

Contact information

Practice address
2 W CRESCENT PARK, WARREN, PA 16365-2111
(814) 723-2333
(814) 723-2355
Mailing address
100 SHENANGO AVE, SHARON, PA 16146-1503
(814) 723-2333
(814) 723-2355

Taxonomy

Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
DH012482L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1034997720001
PA
05
1034997720002
PA
Enumeration date
06/01/2018
Last updated
08/16/2019
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