Provider Demographics
NPI:1245501667
Name:DORSCHER, LEEANN MARIE (RDH)
Entity type:Individual
Prefix:
First Name:LEEANN
Middle Name:MARIE
Last Name:DORSCHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 N 1ST ST STE D
Mailing Address - Street 2:
Mailing Address - City:GRAND JUNCTION
Mailing Address - State:CO
Mailing Address - Zip Code:81501-2175
Mailing Address - Country:US
Mailing Address - Phone:970-314-2966
Mailing Address - Fax:
Practice Address - Street 1:1119 N 1ST ST STE D
Practice Address - Street 2:
Practice Address - City:GRAND JUNCTION
Practice Address - State:CO
Practice Address - Zip Code:81501-2175
Practice Address - Country:US
Practice Address - Phone:970-314-2966
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-17
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO903547124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist