Provider Demographics
NPI:1457716060
Name:HEALTHY DENTAL,PC
Entity Type:Organization
Organization Name:HEALTHY DENTAL,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEIGHTON
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-588-9094
Mailing Address - Street 1:85 ARGONAUT
Mailing Address - Street 2:SUITE #220
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4132
Mailing Address - Country:US
Mailing Address - Phone:714-588-9094
Mailing Address - Fax:
Practice Address - Street 1:2501 NW 229TH AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97124-5506
Practice Address - Country:US
Practice Address - Phone:650-400-4439
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-24
Last Update Date:2015-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD99731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1366460545OtherHEALTH CARE
OR1295168938OtherHEALTH CARE