Provider Demographics
NPI:1851530968
Name:LEONARD FAMILY DENTISTRY
Entity Type:Organization
Organization Name:LEONARD FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:LUDLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:903-587-0506
Mailing Address - Street 1:110 W COLLIN ST
Mailing Address - Street 2:
Mailing Address - City:LEONARD
Mailing Address - State:TX
Mailing Address - Zip Code:75452-2642
Mailing Address - Country:US
Mailing Address - Phone:903-587-0506
Mailing Address - Fax:903-587-0509
Practice Address - Street 1:110 W COLLIN ST
Practice Address - Street 2:
Practice Address - City:LEONARD
Practice Address - State:TX
Practice Address - Zip Code:75452-2642
Practice Address - Country:US
Practice Address - Phone:903-587-0506
Practice Address - Fax:903-587-0509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-12
Last Update Date:2009-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX216931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty