Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | 3078-99 | MS |
NPI | 1023142171 |
---|---|
Provider Name | Dr. Jeffrey Stuart Leblanc |
First Address | Laurel, MS 39440-2654 |
Second Address | Laurel, MS 39440-2654 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/03/2007 |
Last Update Date | 08/07/2007 |