Provider Demographics
NPI:1245345412
Name:LECCA, PETER V (DDS)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:V
Last Name:LECCA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 S DENTON TAP RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019
Mailing Address - Country:US
Mailing Address - Phone:972-304-0968
Mailing Address - Fax:972-393-4628
Practice Address - Street 1:275 S DENTON TAP RD
Practice Address - Street 2:SUITE 150
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019
Practice Address - Country:US
Practice Address - Phone:972-304-0968
Practice Address - Fax:972-393-4628
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist