Provider Demographics
NPI:1770045346
Name:LEOTA, LEUTE (BDS)
Entity Type:Individual
Prefix:
First Name:LEUTE
Middle Name:
Last Name:LEOTA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:LEUTE
Other - Middle Name:
Other - Last Name:PIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX LBJ
Mailing Address - Street 2:
Mailing Address - City:PAGO PAGO
Mailing Address - State:AS
Mailing Address - Zip Code:96799-0010
Mailing Address - Country:US
Mailing Address - Phone:684-633-1222
Mailing Address - Fax:684-633-1256
Practice Address - Street 1:96799 TURNER DRIVE
Practice Address - Street 2:
Practice Address - City:PAGO PAGO
Practice Address - State:AS
Practice Address - Zip Code:96799-0010
Practice Address - Country:US
Practice Address - Phone:684-633-1222
Practice Address - Fax:684-633-1256
Is Sole Proprietor?:No
Enumeration Date:2019-04-03
Last Update Date:2019-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AS209-A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice