Provider Demographics
NPI:1285642561
Name:MICHAEL R LEECH DDS AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:MICHAEL R LEECH DDS AND ASSOCIATES, INC
Other - Org Name:JOHN F LEECH AND MICHAEL R LEECH DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:419-756-1110
Mailing Address - Street 1:630 LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907-1500
Mailing Address - Country:US
Mailing Address - Phone:419-756-1110
Mailing Address - Fax:419-756-1865
Practice Address - Street 1:630 LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-1500
Practice Address - Country:US
Practice Address - Phone:419-756-1110
Practice Address - Fax:419-756-1865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-03
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30 0126041223G0001X
OH30 0189831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty