Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223S0112X | Oral and Maxillofacial Surgeon | 019.026579 | IL |
N | 1223S0112X | Oral and Maxillofacial Surgeon | 3396 | AR |
N | 1223S0112X | Oral and Maxillofacial Surgeon | DN18572 | FL |
Y | 204E00000X | Oral & Maxillofacial Surgeon | 3396 | AR |
NPI | 1487829420 |
---|---|
Provider Name | Dr. Joshua L Leal |
First Address | Fayetteville, AR 72702-4185 |
Second Address | Harrison, AR 72601-3442 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2008 |
Last Update Date | 04/03/2021 |