Provider Demographics
NPI:1508203076
Name:LEIDER, CALEN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:CALEN
Middle Name:H
Last Name:LEIDER
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 1:3064 S BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-6522
Mailing Address - Country:US
Mailing Address - Phone:920-892-6961
Mailing Address - Fax:920-208-7741
Practice Address - Street 1:3064 S BUSINESS DR
Practice Address - Street 2:
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-6522
Practice Address - Country:US
Practice Address - Phone:920-892-6961
Practice Address - Fax:920-208-7741
Is Sole Proprietor?:No
Enumeration Date:2013-05-23
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7053-15122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist