Provider Demographics
NPI:1548775703
Name:DR. LEON FLETTRICH IV, LLC
Entity Type:Organization
Organization Name:DR. LEON FLETTRICH IV, LLC
Other - Org Name:FLETTRICH FAMILY DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEON
Authorized Official - Middle Name:ALBERT
Authorized Official - Last Name:FLETTRICH
Authorized Official - Suffix:IV
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-483-0955
Mailing Address - Street 1:729 N CARROLLTON AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-4708
Mailing Address - Country:US
Mailing Address - Phone:504-483-0955
Mailing Address - Fax:504-488-1947
Practice Address - Street 1:729 N CARROLLTON AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-4708
Practice Address - Country:US
Practice Address - Phone:504-483-0955
Practice Address - Fax:504-488-1947
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-11
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA39101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty