Individual
DR. LEIGHTON ROGER HOLLEY III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
6839 CODY ST, BONNERS FERRY, ID 83805-8613
(214) 558-3202
Mailing address
PO BOX 3206, BONNERS FERRY, ID 83805-3206
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
1002437
WI
1223G0001X
General Practice Dentistry
D-5203
ID
1223G0001X
General Practice Dentistry
DDS-09864
IA
1223G0001X
General Practice Dentistry
Primary
DEN-DEN-LIC-6079
MT
Other
Enumeration date
01/24/2014
Last updated
07/23/2021
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