Provider Demographics
NPI:1003813304
Name:NEBEKER, LELAND W (DMD)
Entity type:Individual
Prefix:DR
First Name:LELAND
Middle Name:W
Last Name:NEBEKER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2233 WILLAMETTE ST
Mailing Address - Street 2:BUILDING E
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97405-2890
Mailing Address - Country:US
Mailing Address - Phone:541-687-4867
Mailing Address - Fax:541-686-9620
Practice Address - Street 1:2233 WILLAMETTE ST
Practice Address - Street 2:BUILDING E
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97405-2890
Practice Address - Country:US
Practice Address - Phone:541-687-4867
Practice Address - Fax:541-686-9620
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR49621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice