Provider Demographics
NPI:1124919766
Name:LEEDS AND WISENER PLLC
Entity type:Organization
Organization Name:LEEDS AND WISENER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:LEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-754-0459
Mailing Address - Street 1:1204 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72830-9159
Mailing Address - Country:US
Mailing Address - Phone:479-977-6453
Mailing Address - Fax:479-207-6678
Practice Address - Street 1:1204 S ROGERS ST
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:AR
Practice Address - Zip Code:72830-9159
Practice Address - Country:US
Practice Address - Phone:479-977-6453
Practice Address - Fax:479-207-6678
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-11
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty