Provider Demographics
NPI:1669524617
Name:LEERSSEN, DARCY R (DDS)
Entity type:Individual
Prefix:DR
First Name:DARCY
Middle Name:R
Last Name:LEERSSEN
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 1:1846 WARM SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-8029
Mailing Address - Country:US
Mailing Address - Phone:706-322-6551
Mailing Address - Fax:706-576-5154
Practice Address - Street 1:1846 WARM SPRINGS RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-8029
Practice Address - Country:US
Practice Address - Phone:706-322-6551
Practice Address - Fax:706-576-5154
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0089491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice