Provider Demographics
NPI:1184820466
Name:THOMAS A. LEECH, D.D.S.
Entity Type:Organization
Organization Name:THOMAS A. LEECH, D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-544-2001
Mailing Address - Street 1:1920 EAST HWY 54
Mailing Address - Street 2:SUITE 570
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713
Mailing Address - Country:US
Mailing Address - Phone:919-544-2001
Mailing Address - Fax:919-484-8076
Practice Address - Street 1:1920 EAST HWY 54
Practice Address - Street 2:SUITE 570
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713
Practice Address - Country:US
Practice Address - Phone:919-544-2001
Practice Address - Fax:919-484-8076
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC56701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1083797377Medicare UPIN
NC428990Medicare UPIN