Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 105212 | CO |
NPI | 1003817362 |
---|---|
Provider Name | Mr. Leonard Lee Mcadams |
First Address | Cedaredge, CO 81413-0279 |
Second Address | Cedaredge, CO 81413-3824 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02052124 | STATE PROVIDER # (01) | CO |