Provider Demographics
NPI:1538917653
Name:DISTLER, LEIGHANN NICOLE (DDS)
Entity type:Individual
Prefix:
First Name:LEIGHANN
Middle Name:NICOLE
Last Name:DISTLER
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 1:1521 WALMART DR STE 301
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-8347
Mailing Address - Country:US
Mailing Address - Phone:513-282-6200
Mailing Address - Fax:513-282-6201
Practice Address - Street 1:1521 WALMART DR STE 301
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-8347
Practice Address - Country:US
Practice Address - Phone:513-282-6200
Practice Address - Fax:513-282-6201
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30-0275041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice