Provider Demographics
NPI:1942721477
Name:WAITS, LEAH DANIELLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DANIELLE
Last Name:WAITS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6414 U S HIGHWAY 98 STE 10
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-7838
Mailing Address - Country:US
Mailing Address - Phone:601-543-3745
Mailing Address - Fax:
Practice Address - Street 1:6414 U S HIGHWAY 98 STE 10
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-7838
Practice Address - Country:US
Practice Address - Phone:601-543-3745
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-06
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3951-171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice