Provider Demographics
NPI:1669653697
Name:LECLERC, BRYAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:
Last Name:LECLERC
Suffix:
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:PO BOX 42
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04212-0042
Mailing Address - Country:US
Mailing Address - Phone:207-784-4222
Mailing Address - Fax:207-784-8798
Practice Address - Street 1:2 GREAT FALLS PLZ
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-5966
Practice Address - Country:US
Practice Address - Phone:207-784-4222
Practice Address - Fax:207-784-8798
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME40541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice