Individual provider Active NPI

Benjamin Joseph Leithold, DDS

  • Dentist
  • Beavercreek, OH
National Provider Identifier
1588397707
Registry record updated Jul 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
30.026922 Issued in OH
Practice address
2355 Lakeview Dr
Beavercreek, OH 45431-3695
Phone
(937) 427-1195
NPI assigned
Jul 5, 2022
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 5, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 30.026922 OH Primary

Addresses

Primary practice location

2355 Lakeview Dr
Beavercreek, OH 45431-3695

Mailing address

2214 Sulky CT
Beavercreek, OH 45434-5677
Phone (937) 307-2301

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

LicenseStateTypeSpecialty
30.026922OHMDDentist

NPI Registry JSON

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

{
    "created_epoch": "1656979200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1588397707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2214 SULKY CT",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454345677",
            "telephone_number": "937-307-2301"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2355 LAKEVIEW DR",
            "city": "BEAVERCREEK",
            "state": "OH",
            "postal_code": "454313695",
            "telephone_number": "937-427-1195"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEITHOLD",
        "first_name": "BENJAMIN",
        "middle_name": "JOSEPH",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-07-05",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OH",
            "license": "30.026922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Beavercreek, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; 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.