Nicholas John Ledderhof, BSCH, DDS, MSC, FRCD

Primary specialty

Oral & Maxillofacial Surgery (D.M.D.)Taxonomy code 204E00000X

License

88428 Issued in ZZ

Practice address

1930 Alcoa Hwy. Medical Building a, Suite 335
Knoxville, TN 37920-1514

Phone

(865) 305-9022

Fax

(865) 305-9026

NPI assigned

Apr 26, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1524700800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1542758400000",
    "number": "1821586793",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1930 ALCOA HWY. MEDICAL BUILDING A, SUITE 335",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379201514",
            "telephone_number": "865-305-9022",
            "fax_number": "865-305-9026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1930 ALCOA HWY. MEDICAL BUILDING A, SUITE 335",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379201514",
            "telephone_number": "865-305-9022",
            "fax_number": "865-305-9026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LEDDERHOF",
        "first_name": "NICHOLAS",
        "middle_name": "JOHN",
        "name_prefix": "Dr.",
        "credential": "BSCH, DDS, MSC, FRCD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-04-26",
        "last_updated": "2018-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "204E00000X",
            "taxonomy_group": "",
            "desc": "Oral & Maxillofacial Surgery",
            "state": "ZZ",
            "license": "88428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Francis P Lebuffe, MD
• Leconte Medical Group, LLC
• Leconte Recovery Center
• Christie Elizabeth Ledbetter
• Kathryn Faye Ledbetter, CRNA
• Jacob Judah Ledlow
• Natasha Nicole Lee-Mayes, CNA
• Alexandra Lee, PSY.D.
• Allison Lee
• Amber Lee, LPN

• Oral & Maxillofacial Surgery (D.M.D.) in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Oral & Maxillofacial Surgery (D.M.D.) in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.