Provider Demographics
NPI:1235255654
Name:POWELL, LELAND V (DDS)
Entity Type:Individual
Prefix:
First Name:LELAND
Middle Name:V
Last Name:POWELL
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 1:2682 ANNA CAROLINE DR
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84128-5003
Mailing Address - Country:US
Mailing Address - Phone:801-974-5437
Mailing Address - Fax:801-964-9003
Practice Address - Street 1:2682 ANNA CAROLINE DR
Practice Address - Street 2:
Practice Address - City:WEST VALLEY CITY
Practice Address - State:UT
Practice Address - Zip Code:84128-5003
Practice Address - Country:US
Practice Address - Phone:801-974-5437
Practice Address - Fax:801-964-9003
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT474839699231223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry