Provider Demographics
NPI:1003963281
Name:LEIM, JON PAUL (DDS, PA)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:PAUL
Last Name:LEIM
Suffix:
Gender:M
Credentials:DDS, PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPE
Mailing Address - State:AR
Mailing Address - Zip Code:71801-8103
Mailing Address - Country:US
Mailing Address - Phone:870-777-6762
Mailing Address - Fax:870-777-5058
Practice Address - Street 1:110 W 18TH ST
Practice Address - Street 2:
Practice Address - City:HOPE
Practice Address - State:AR
Practice Address - Zip Code:71801-8103
Practice Address - Country:US
Practice Address - Phone:870-777-6762
Practice Address - Fax:870-777-5058
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR18151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice