Provider Demographics
NPI:1366460545
Name:MILLER, LEIGHTON THOMAS (DDS)
Entity Type:Individual
Prefix:
First Name:LEIGHTON
Middle Name:THOMAS
Last Name:MILLER
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 1:555 W BENJAMIN HOLT DR
Mailing Address - Street 2:BUILDING B
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-3839
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3251 COORS BLVD SW STE E1
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-5203
Practice Address - Country:US
Practice Address - Phone:505-208-7565
Practice Address - Fax:505-318-1732
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA56404122300000X
OR9973122300000X
UT92160589921122300000X
TX33797122300000X
PADS043347122300000X
HI12561223G0001X
NMDD4504122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice