Provider Demographics
NPI:1891996633
Name:DORNBIER, LEASA MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEASA
Middle Name:MARIE
Last Name:DORNBIER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1040 OLD POST RD
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-3065
Mailing Address - Country:US
Mailing Address - Phone:308-254-7171
Mailing Address - Fax:
Practice Address - Street 1:1040 OLD POST RD
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-3065
Practice Address - Country:US
Practice Address - Phone:308-254-7171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2016-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE66831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice