Provider Demographics
NPI:1518905389
Name:DILLEY, LEAH RENEE (DDS)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:RENEE
Last Name:DILLEY
Suffix:
Gender:F
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 269
Mailing Address - Street 2:100 N. BROADWAY STREET
Mailing Address - City:OAKTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47561-0269
Mailing Address - Country:US
Mailing Address - Phone:812-745-4151
Mailing Address - Fax:812-745-4152
Practice Address - Street 1:100 N. BROADWAY STREET
Practice Address - Street 2:
Practice Address - City:OAKTOWN
Practice Address - State:IN
Practice Address - Zip Code:47561-7000
Practice Address - Country:US
Practice Address - Phone:812-745-4151
Practice Address - Fax:812-745-4152
Is Sole Proprietor?:No
Enumeration Date:2006-06-03
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010355A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200357310AMedicaid
IN200418020Medicaid