Provider Demographics
NPI:1245352186
Name:LEUCHT, BRETT ETHAN
Entity type:Individual
Prefix:DR
First Name:BRETT
Middle Name:ETHAN
Last Name:LEUCHT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 TUCKER RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-2952
Mailing Address - Country:US
Mailing Address - Phone:502-491-3323
Mailing Address - Fax:502-491-3330
Practice Address - Street 1:2707 TUCKER RD
Practice Address - Street 2:SUITE 106
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-2952
Practice Address - Country:US
Practice Address - Phone:502-491-3323
Practice Address - Fax:502-491-3330
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7295122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist