Individual
DR. NICHOLAS JOHN LEDDERHOF
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BSCH, DDS, MSC, FRCD
Contact information
Practice address
1930 ALCOA HWY. MEDICAL BUILDING A, SUITE 335, KNOXVILLE, TN 37920-1514
(865) 305-9022
(865) 305-9026
Mailing address
1930 ALCOA HWY. MEDICAL BUILDING A, SUITE 335, KNOXVILLE, TN 37920-1514
(865) 305-9022
(865) 305-9026
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
Primary
88428
ZZ
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2018
Last updated
11/21/2018
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