Provider Demographics
NPI:1184839573
Name:COMPREHENSIVE DENTAL CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEIGH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:978-302-3803
Mailing Address - Street 1:474 BROADWAY APT 110
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02145-2630
Mailing Address - Country:US
Mailing Address - Phone:617-623-2223
Mailing Address - Fax:
Practice Address - Street 1:474 BROADWAY APT 110
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02145-2630
Practice Address - Country:US
Practice Address - Phone:617-623-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA202541223G0001X
MA207571223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Not Answered1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty