Provider Demographics
NPI:1962006965
Name:LEGER, BRIANA (RDH)
Entity Type:Individual
Prefix:MRS
First Name:BRIANA
Middle Name:
Last Name:LEGER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 SKIBO RD STE C3
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-1500
Mailing Address - Country:US
Mailing Address - Phone:910-484-5141
Mailing Address - Fax:
Practice Address - Street 1:1916 SKIBO RD STE C3
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28314-1500
Practice Address - Country:US
Practice Address - Phone:910-484-5141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12481124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC12481OtherNORTH CAROLINA DENTAL HYGIENE LICENSE
NC21146794OtherNC DRIVERS LICENSE