John William Leclair, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DS017092L Issued in PA

Practice address

1315 West College Ave.
Suite 201
State College, PA 16801

Phone

(814) 954-7620

Fax

(814) 308-9985

NPI assigned

Mar 2, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• John W. Leclair DMD

  • General Practice Dentistry
  • State College, PA
  • NPI 1942747183
  NPD (past) Authorized official

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

{
    "created_epoch": "1172793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482969600000",
    "number": "1396874863",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1315 WEST COLLEGE AVE.",
            "address_2": "SUITE 201",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "16801",
            "telephone_number": "814-954-7620",
            "fax_number": "814-237-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1315 WEST COLLEGE AVE.",
            "address_2": "SUITE 201",
            "city": "STATE COLLEGE",
            "state": "PA",
            "postal_code": "16801",
            "telephone_number": "814-954-7620",
            "fax_number": "814-308-9985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LECLAIR",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-02",
        "last_updated": "2016-12-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "PA",
            "license": "DS017092L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010324310001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in State College, PA
• Providers in State College, PA by specialty
• General Practice Dentistry in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2016; 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.