Provider Demographics
NPI:1174666283
Name:MCGAHA, LEONARD EDWARD (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:EDWARD
Last Name:MCGAHA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 N FANT ST
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-4708
Mailing Address - Country:US
Mailing Address - Phone:864-226-8559
Mailing Address - Fax:864-226-8853
Practice Address - Street 1:1514 N FANT ST
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-4708
Practice Address - Country:US
Practice Address - Phone:864-226-8559
Practice Address - Fax:864-226-8853
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1337204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZA9593Medicaid
SC1512Medicare PIN