Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 128900 | AK |
NPI | 1659784098 |
---|---|
Provider Name | John Leach |
First Address | Anchorage, AK 99515-1909 |
Second Address | Anchorage, AK 99515-1909 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2014 |
Last Update Date | 10/02/2020 |