Provider Demographics
NPI:1013575356
Name:POPE, LEAH KATHERINE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:KATHERINE
Last Name:POPE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12372 WOODMAR PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8060
Mailing Address - Country:US
Mailing Address - Phone:219-614-6000
Mailing Address - Fax:
Practice Address - Street 1:320 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1780
Practice Address - Country:US
Practice Address - Phone:219-690-8866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-02
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.0323241223G0001X
IN12013299A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice