Provider Demographics
NPI:1679679559
Name:LADLEY, LEAH M (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:M
Last Name:LADLEY
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 1:265 HATTERAS AVE
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-7456
Mailing Address - Country:US
Mailing Address - Phone:352-241-8200
Mailing Address - Fax:
Practice Address - Street 1:265 HATTERAS AVE
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-7456
Practice Address - Country:US
Practice Address - Phone:352-241-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL125251223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL64805OtherBCBS
970832OtherUNITED CONCORDIA