Provider Demographics
NPI:1902914666
Name:CHARCHUT, LEONARD HENRY (DDS, MS)
Entity type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:HENRY
Last Name:CHARCHUT
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Gender:M
Credentials:DDS, MS
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Mailing Address - Street 1:705 SNOW RD
Mailing Address - Street 2:STE. E
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-4086
Mailing Address - Country:US
Mailing Address - Phone:517-321-0238
Mailing Address - Fax:517-321-0063
Practice Address - Street 1:705 SNOW RD
Practice Address - Street 2:STE. E
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-4086
Practice Address - Country:US
Practice Address - Phone:517-321-0238
Practice Address - Fax:517-321-0063
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI100681223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics