D. Blaine Leeds Dbldds PA

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

AR3197 Issued in AR

Legal business name

D. BLAINE LEEDS DBLDDS PA

Practice address

1101 E Poplar St
Clarksville, AR 72830-4420

Phone

(479) 754-3357

Fax

(479) 754-0167

NPI assigned

Jan 5, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Danny Blaine Leeds, DDS

Title

Dentist

Phone

(479) 754-3357

Specialties & licenses 1

Addresses

Other identifiers 3

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1231113600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231113600000",
    "number": "1013153592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1101 E POPLAR ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304420",
            "telephone_number": "479-754-3357",
            "fax_number": "479-754-0167"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1101 E POPLAR ST",
            "city": "CLARKSVILLE",
            "state": "AR",
            "postal_code": "728304420",
            "telephone_number": "479-754-3357",
            "fax_number": "479-754-0167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "D. BLAINE LEEDS DBLDDS PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-01-05",
        "last_updated": "2009-01-05",
        "status": "A",
        "authorized_official_last_name": "LEEDS",
        "authorized_official_first_name": "DANNY",
        "authorized_official_middle_name": "BLAINE",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "479-754-3357",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "AR",
            "license": "AR3197",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI",
            "identifier": "485722",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/ BLUE SHIELD",
            "identifier": "5T397",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "136700608",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Clarksville, AR
• Providers in Clarksville, AR by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.