Provider Demographics
NPI:1801012851
Name:LEITHEAD, JAMES A JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:A
Last Name:LEITHEAD
Suffix:JR
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 1:615 W. COLLEGE ST.
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605
Mailing Address - Country:US
Mailing Address - Phone:337-477-6063
Mailing Address - Fax:337-478-8095
Practice Address - Street 1:615 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-1521
Practice Address - Country:US
Practice Address - Phone:337-478-8091
Practice Address - Fax:337-478-8095
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA31671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics