Provider Demographics
NPI:1821448242
Name:NELS, LEAHA (DDS)
Entity Type:Individual
Prefix:
First Name:LEAHA
Middle Name:
Last Name:NELS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LEAHA
Other - Middle Name:
Other - Last Name:HUSKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 N DOUGLAS BLVD STE T
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-3328
Mailing Address - Country:US
Mailing Address - Phone:405-455-9057
Mailing Address - Fax:
Practice Address - Street 1:101 N DOUGLAS BLVD STE T
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-3328
Practice Address - Country:US
Practice Address - Phone:405-455-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2020-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK67941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice