Provider Demographics
NPI:1770332306
Name:GARG, LEENA (DDS)
Entity type:Individual
Prefix:DR
First Name:LEENA
Middle Name:
Last Name:GARG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:571 YOPP RD STE 308
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28540-3683
Mailing Address - Country:US
Mailing Address - Phone:910-716-0101
Mailing Address - Fax:910-294-8874
Practice Address - Street 1:571 YOPP RD STE 308
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28540-3683
Practice Address - Country:US
Practice Address - Phone:910-716-0101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-15
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC139091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice