Provider Demographics
NPI:1467646422
Name:LEICHTY, WESLEY JAMES II (DDS)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:JAMES
Last Name:LEICHTY
Suffix:II
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 1:1590 N RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8073
Mailing Address - Country:US
Mailing Address - Phone:909-875-2050
Mailing Address - Fax:909-875-2185
Practice Address - Street 1:1590 N RIVERSIDE AVE
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376
Practice Address - Country:US
Practice Address - Phone:909-875-2050
Practice Address - Fax:909-875-2185
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54819122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist