Jason Allan Leach, D.M.D.
Individual provider Active NPI Dentist · Horn Lake, MS
NPI 1962543876 · NPPES record last updated Dec 23, 2015
Key facts
- NPI
- 1962543876
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- D6188 (AZ)
- Practice address
- 2154 Goodman Rd W
Horn Lake, MS 38637-1303 - Phone
- (662) 393-9200
- NPI assigned
- Feb 12, 2007
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D6188 | AZ | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| General Dentistry 4 Kids-Tucson, PLLC | Past |
Accepting new patients | |
| Happy Smiles LLC | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | D6188 | AZ | Yes |
Addresses
Primary practice location
2154 Goodman Rd W
Horn Lake, MS 38637-1303
Mailing address
8151 E Indian Bend Rd
Ste 111
Scottsdale, AZ 85250-4826
Phone (480) 607-9999
Other providers in Horn Lake, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 23, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.