Provider Demographics
NPI:1992036099
Name:THE LEIGHTON INSTITUTE FOR AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGER
Entity Type:Organization
Organization Name:THE LEIGHTON INSTITUTE FOR AESTHETIC AND RECONSTRUCTIVE PLASTIC SURGER
Other - Org Name:WILLIAM D. LEIGHTON, MD
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-948-3250
Mailing Address - Street 1:7425 E SHEA BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-6411
Mailing Address - Country:US
Mailing Address - Phone:480-948-3250
Mailing Address - Fax:480-905-6941
Practice Address - Street 1:7425 E SHEA BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6411
Practice Address - Country:US
Practice Address - Phone:480-948-3250
Practice Address - Fax:480-905-6941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-29
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ12814208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty