Provider Demographics
NPI:1295480044
Name:LEAVITT, ISELA GARCIA (RDH)
Entity type:Individual
Prefix:
First Name:ISELA
Middle Name:GARCIA
Last Name:LEAVITT
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 1:619 E 7TH PL
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-6313
Mailing Address - Country:US
Mailing Address - Phone:602-625-6495
Mailing Address - Fax:
Practice Address - Street 1:619 E 7TH PL
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-6313
Practice Address - Country:US
Practice Address - Phone:602-625-6495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-18
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZHO1919124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist