Provider Demographics
NPI:1275277170
Name:LEAH C. DIVITO, DDS, LLC
Entity type:Organization
Organization Name:LEAH C. DIVITO, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:CHEYANN
Authorized Official - Last Name:DIVITO
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:234-269-5288
Mailing Address - Street 1:5655 HUDSON DR STE 100
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:OH
Mailing Address - Zip Code:44236-4454
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5655 HUDSON DR STE 100
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:OH
Practice Address - Zip Code:44236-4454
Practice Address - Country:US
Practice Address - Phone:234-269-5288
Practice Address - Fax:234-269-5289
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1699056325OtherPERSONAL NPI NUMBER