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1952495491
CASEY JON LEAVITT
POCATELLO, ID
NPI
1952495491
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
1223G0001X Dentist, General Practice
(Licence: ID D3630)
Enumeration Date
2006-10-02
Last Update Date
2007-07-08
Business Address
Dr. CASEY JON LEAVITT DDS
333 W. CEDAR
POCATELLO, ID 83201-5045
Phone number: 208-233-6900
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Mailing Address
Dr. CASEY JON LEAVITT DDS
333 W. CEDAR
POCATELLO, ID 83201-5045
Phone number: 208-233-6900
Copy
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