Provider Demographics
NPI:1396184172
Name:MCBRIDE, LEANNA MARIE MARKING (DDS)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE MARKING
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:MARIE
Other - Last Name:MARKING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1604 GOLF COURSE RD
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-8648
Mailing Address - Country:US
Mailing Address - Phone:218-326-0339
Mailing Address - Fax:
Practice Address - Street 1:1604 GOLF COURSE RD
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-8648
Practice Address - Country:US
Practice Address - Phone:218-326-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-14
Last Update Date:2015-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND132441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice