Provider Demographics
NPI:1659805075
Name:LEININGER, RYAN MICHAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:MICHAEL
Last Name:LEININGER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 W HIGHWAY 95
Mailing Address - Street 2:PO BOX 420
Mailing Address - City:PARMA
Mailing Address - State:ID
Mailing Address - Zip Code:83660-5519
Mailing Address - Country:US
Mailing Address - Phone:208-722-6400
Mailing Address - Fax:
Practice Address - Street 1:205 W HIGHWAY 95
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:ID
Practice Address - Zip Code:83660-5519
Practice Address - Country:US
Practice Address - Phone:208-722-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist