Active NPI
Brandon Edward Leeser, DDS
- Dentist
- Austin, TX
National Provider Identifier
1023265410
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 24953
- Practice address
- 4911 Harmon Ave
Austin, TX 78751-2710 - Phone
- (512) 477-7454
- NPI assigned
- Aug 27, 2008
- Last updated
- Jan 6, 2021
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 24953 | TX | Primary |
Addresses
Primary practice location
4911 Harmon Ave
Austin, TX 78751-2710
Mailing address
4911 Harmon Ave
Austin, TX 78751-2710
Phone (512) 477-7454
Other practice location 1
2441 21St Street
U S a Dentac BLDG
Fort Campbell, KY 42223-5369
Phone (270) 798-8614
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 24953 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1219795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609891200000",
"number": "1023265410",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4911 HARMON AVE",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787512710",
"telephone_number": "512-477-7454"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4911 HARMON AVE",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787512710",
"telephone_number": "512-477-7454"
}
],
"practiceLocations": [
{
"address_1": "2441 21ST STREET",
"address_2": "U S A DENTAC BLDG",
"address_purpose": "LOCATION",
"city": "FORT CAMPBELL",
"state": "KY",
"postal_code": "422235369",
"country_code": "US",
"telephone_number": "270-798-8614",
"fax_number": "270-798-8633",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "LEESER",
"first_name": "BRANDON",
"middle_name": "EDWARD",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2008-08-27",
"last_updated": "2021-01-06",
"certification_date": "2021-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "24953",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.