Provider Demographics
NPI:1487453254
Name:DANNY BLAINE LEEDS DDS
Entity type:Organization
Organization Name:DANNY BLAINE LEEDS DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNY
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:LEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:479-754-0459
Mailing Address - Street 1:1606 JUANITA LN STE D&G
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920-2548
Mailing Address - Country:US
Mailing Address - Phone:415-435-3371
Mailing Address - Fax:
Practice Address - Street 1:1606 JUANITA LN STE D&G
Practice Address - Street 2:
Practice Address - City:TIBURON
Practice Address - State:CA
Practice Address - Zip Code:94920-2548
Practice Address - Country:US
Practice Address - Phone:415-435-3371
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-12
Last Update Date:2025-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental