Provider Demographics
NPI:1346978541
Name:LEAH THOMAS DDS LLC
Entity Type:Organization
Organization Name:LEAH THOMAS DDS LLC
Other - Org Name:AVENUE FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-614-6000
Mailing Address - Street 1:12372 WOODMAR PL
Mailing Address - Street 2:
Mailing Address - City:CEDAR LAKE
Mailing Address - State:IN
Mailing Address - Zip Code:46303-8060
Mailing Address - Country:US
Mailing Address - Phone:219-614-6000
Mailing Address - Fax:
Practice Address - Street 1:320 E COMMERCIAL AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-1780
Practice Address - Country:US
Practice Address - Phone:219-690-8866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-15
Last Update Date:2023-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty