Provider Demographics
NPI:1629129648
Name:PODRUCH, LEEANN (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEEANN
Middle Name:
Last Name:PODRUCH
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 1:7360 SPEAR ST
Mailing Address - Street 2:
Mailing Address - City:SHELBURNE
Mailing Address - State:VT
Mailing Address - Zip Code:05482-6572
Mailing Address - Country:US
Mailing Address - Phone:802-985-3661
Mailing Address - Fax:802-985-5261
Practice Address - Street 1:1050 HINESBURG RD
Practice Address - Street 2:
Practice Address - City:SOUTH BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05403-7612
Practice Address - Country:US
Practice Address - Phone:802-864-1890
Practice Address - Fax:802-864-7526
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT6901223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice