Provider Demographics
NPI:1275762189
Name:LEATHERWOOD, SAMANTHA A (DMD)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:A
Last Name:LEATHERWOOD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 OLD DENTON RD STE 126
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75007-5099
Mailing Address - Country:US
Mailing Address - Phone:972-446-1111
Mailing Address - Fax:972-446-1112
Practice Address - Street 1:3044 OLD DENTON RD STE 126
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:TX
Practice Address - Zip Code:75007-5099
Practice Address - Country:US
Practice Address - Phone:972-446-1111
Practice Address - Fax:972-446-1112
Is Sole Proprietor?:No
Enumeration Date:2009-07-13
Last Update Date:2011-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX247761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice