Provider Demographics
NPI:1881803468
Name:JAMES B. LEAVITT D.M.D., P.C.
Entity type:Organization
Organization Name:JAMES B. LEAVITT D.M.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT- CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BOYD
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:520-458-4060
Mailing Address - Street 1:901 HEATHER DR
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4934
Mailing Address - Country:US
Mailing Address - Phone:520-459-3209
Mailing Address - Fax:520-458-6008
Practice Address - Street 1:701 E WILCOX DR
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-2538
Practice Address - Country:US
Practice Address - Phone:520-458-4060
Practice Address - Fax:520-458-6008
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD36981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty