Provider Demographics
NPI:1396741146
Name:LEITNER, JOHN ORR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ORR
Last Name:LEITNER
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 1:575 ROBBINS RD
Mailing Address - Street 2:STE B
Mailing Address - City:GRAND HAVEN
Mailing Address - State:MI
Mailing Address - Zip Code:49417-2695
Mailing Address - Country:US
Mailing Address - Phone:616-842-2850
Mailing Address - Fax:616-842-7205
Practice Address - Street 1:575 ROBBINS RD
Practice Address - Street 2:STE B
Practice Address - City:GRAND HAVEN
Practice Address - State:MI
Practice Address - Zip Code:49417-2695
Practice Address - Country:US
Practice Address - Phone:616-842-2850
Practice Address - Fax:616-842-7205
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-27
Last Update Date:2007-07-08
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-28
Provider Licenses
StateLicense IDTaxonomies
MI0143481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice