Provider Demographics
NPI:1275738312
Name:LEITHNER, ERIC SEAN (DMD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:SEAN
Last Name:LEITHNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 HANOVER DR
Mailing Address - Street 2:
Mailing Address - City:VILLA RICA
Mailing Address - State:GA
Mailing Address - Zip Code:30180-7200
Mailing Address - Country:US
Mailing Address - Phone:770-949-1680
Mailing Address - Fax:
Practice Address - Street 1:8590 BOWDEN ST
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-4525
Practice Address - Country:US
Practice Address - Phone:770-949-1680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA121851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice