Provider Demographics
NPI:1598266983
Name:LEAF DENTAL
Entity Type:Organization
Organization Name:LEAF DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:AZITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEDIGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-425-4172
Mailing Address - Street 1:5509 PLEASANT VALLEY DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-5249
Mailing Address - Country:US
Mailing Address - Phone:916-425-4172
Mailing Address - Fax:
Practice Address - Street 1:5509 PLEASANT VALLEY DR STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023-5249
Practice Address - Country:US
Practice Address - Phone:916-425-4172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty