Provider Demographics
NPI:1417361700
Name:DAVIS, LEAH B (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:B
Last Name:DAVIS
Suffix:
Gender:F
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-6392
Mailing Address - Country:US
Mailing Address - Phone:217-337-6000
Mailing Address - Fax:
Practice Address - Street 1:1209 E COLORADO AVE
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-6392
Practice Address - Country:US
Practice Address - Phone:217-337-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-16
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019030590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist