Provider Demographics
NPI:1497831275
Name:LEBLANC, DENNIS E (DDS)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:E
Last Name:LEBLANC
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:PO BOX 290
Mailing Address - Street 2:296 MAIN ST
Mailing Address - City:DERBY
Mailing Address - State:VT
Mailing Address - Zip Code:05829
Mailing Address - Country:US
Mailing Address - Phone:802-766-4711
Mailing Address - Fax:802-766-8081
Practice Address - Street 1:296 MAIN ST
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:VT
Practice Address - Zip Code:05829
Practice Address - Country:US
Practice Address - Phone:802-766-4711
Practice Address - Fax:802-766-8081
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT687122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT0004749Medicaid