Provider Demographics
NPI:1942345103
Name:LEINEN, NATHAN ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATHAN
Middle Name:ALLEN
Last Name:LEINEN
Suffix:
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 1:1705 N ANKENY BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:ANKENY
Mailing Address - State:IA
Mailing Address - Zip Code:50023-4102
Mailing Address - Country:US
Mailing Address - Phone:515-446-0733
Mailing Address - Fax:
Practice Address - Street 1:1705 N ANKENY BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50023-4102
Practice Address - Country:US
Practice Address - Phone:515-446-0733
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA082601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0444208Medicaid