Provider Demographics
NPI:1922650175
Name:JEREMY A. LEDGER, D.M.D, P.A.
Entity Type:Organization
Organization Name:JEREMY A. LEDGER, D.M.D, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:LEDGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-628-3443
Mailing Address - Street 1:3640 S SUNCOAST BLVD
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-2617
Mailing Address - Country:US
Mailing Address - Phone:352-628-3443
Mailing Address - Fax:352-628-9199
Practice Address - Street 1:3640 S SUNCOAST BLVD
Practice Address - Street 2:
Practice Address - City:HOMOSASSA
Practice Address - State:FL
Practice Address - Zip Code:34448-2617
Practice Address - Country:US
Practice Address - Phone:352-628-3443
Practice Address - Fax:352-628-9199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-09
Last Update Date:2019-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty