Provider Demographics
NPI:1669819090
Name:ZIEGLER, LEAHA COLLEEN (RDH, BSDH)
Entity Type:Individual
Prefix:
First Name:LEAHA
Middle Name:COLLEEN
Last Name:ZIEGLER
Suffix:
Gender:F
Credentials:RDH, BSDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9955 NORTH DECATUR STREET
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97203
Mailing Address - Country:US
Mailing Address - Phone:503-267-4821
Mailing Address - Fax:
Practice Address - Street 1:2004 LLOYD CTR
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97232-1309
Practice Address - Country:US
Practice Address - Phone:503-207-4092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-24
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH5895124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist