Provider Demographics
NPI:1245704923
Name:GRACE LEEDY, LLC
Entity type:Organization
Organization Name:GRACE LEEDY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:E
Authorized Official - Last Name:LEEDY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-989-0452
Mailing Address - Street 1:10881 W ASBURY AVE STE 210
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80227-1970
Mailing Address - Country:US
Mailing Address - Phone:303-989-0452
Mailing Address - Fax:
Practice Address - Street 1:10881 W ASBURY AVE STE 210
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80227-1970
Practice Address - Country:US
Practice Address - Phone:303-989-0452
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty