Provider Demographics
NPI:1619007739
Name:LEACH, JOSEPH T JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:T
Last Name:LEACH
Suffix:JR
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 1:3525 W DUBLIN GRANVILLE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43235-7900
Mailing Address - Country:US
Mailing Address - Phone:614-764-1178
Mailing Address - Fax:614-764-3713
Practice Address - Street 1:3525 W DUBLIN GRANVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43235-7900
Practice Address - Country:US
Practice Address - Phone:614-764-1178
Practice Address - Fax:614-764-3713
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH154691223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice