Provider Demographics
NPI:1689726531
Name:LEYDER, RONALD PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:PAUL
Last Name:LEYDER
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 1:7166 S CROTON HARDY DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337
Mailing Address - Country:US
Mailing Address - Phone:231-652-1663
Mailing Address - Fax:231-652-2259
Practice Address - Street 1:7166 S CROTON HARDY DRIVE
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337
Practice Address - Country:US
Practice Address - Phone:231-652-1663
Practice Address - Fax:231-652-2259
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2020-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI0128211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2901012821OtherDENTIST LICENSE
MI5315073790OtherCONTROLLED SUBSTANCE LICENSE