Provider Demographics
NPI:1174724132
Name:LEEN, DOUGLAS VERNER (DDS)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:VERNER
Last Name:LEEN
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:PO BOX 341
Mailing Address - Street 2:BUOY 54 WRANGELL NARROWS, KUPREANOF ISLAND
Mailing Address - City:PETERSBURG
Mailing Address - State:AK
Mailing Address - Zip Code:99833-0341
Mailing Address - Country:US
Mailing Address - Phone:907-518-0335
Mailing Address - Fax:
Practice Address - Street 1:222TONGASS DRIVE
Practice Address - Street 2:SEARHC DENTAL CLINIC--MT. EDGECUMBE HOSPITAL
Practice Address - City:SITKA
Practice Address - State:AK
Practice Address - Zip Code:99835
Practice Address - Country:US
Practice Address - Phone:907-966-8343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAA 830122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist