| NPI | 1215015250 |
|---|---|
| Former Legal Business Name | JEFFREY R LEIDY DMD LLC |
| Entity Type | Organization |
| Authorized Contact | JEFFREY RANDALL LEIDY President Owner 757-463-1500 |
| Organization Subpart ? | No |
| Primary Taxonomy | 122300000X Dentist (Licence: VA 0401006498) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-07-14 |