Individual
TYLER LEAVITT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
3009 HIGHWAY K, O FALLON, MO 63368-8696
(636) 379-7552
Mailing address
1200 E LINDEN AVE, SAINT LOUIS, MO 63117-1315
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2018002229
MO
Other
Enumeration date
02/25/2018
Last updated
02/25/2018
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