Provider Demographics
NPI:1013681584
Name:BRECK LEACH DMD, PLLC
Entity Type:Organization
Organization Name:BRECK LEACH DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRECK
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:701-252-6005
Mailing Address - Street 1:1209 5TH AVE SE STE 6
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:ND
Mailing Address - Zip Code:58401-5601
Mailing Address - Country:US
Mailing Address - Phone:701-252-6005
Mailing Address - Fax:701-251-9188
Practice Address - Street 1:1209 5TH AVE SE STE 6
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:ND
Practice Address - Zip Code:58401-5601
Practice Address - Country:US
Practice Address - Phone:701-252-6005
Practice Address - Fax:701-251-9188
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-06
Last Update Date:2021-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental