Provider Demographics
NPI:1447385125
Name:JOSHUA E LEUTE DDS SC
Entity Type:Organization
Organization Name:JOSHUA E LEUTE DDS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEUTE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:262-284-5884
Mailing Address - Street 1:1317 W GRAND AVENUE
Mailing Address - Street 2:
Mailing Address - City:PORT WASHINGTON
Mailing Address - State:WI
Mailing Address - Zip Code:53074
Mailing Address - Country:US
Mailing Address - Phone:262-284-5884
Mailing Address - Fax:262-284-1840
Practice Address - Street 1:1317 W GRAND AVENUE
Practice Address - Street 2:
Practice Address - City:PORT WASHINGTON
Practice Address - State:WI
Practice Address - Zip Code:53074
Practice Address - Country:US
Practice Address - Phone:262-284-5884
Practice Address - Fax:262-284-1840
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-22
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50007381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33589200Medicaid
WI33814500Medicaid