Organization
LEAVITT ORTHODONTICS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TYLER LEAVITT DDS, MSD (OWNER/DENTIST)
(208) 240-5219
Entity
Organization
Contact information
Practice address
1455 BENCH RD STE A, POCATELLO, ID 83201-5084
(208) 237-3330
Mailing address
1455 BENCH RD STE A, POCATELLO, ID 83201-5084
(208) 237-3330
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
12/12/2023
Last updated
12/12/2023
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