Provider Demographics
NPI:1780794792
Name:RONALD K LEACH DDS PA
Entity type:Organization
Organization Name:RONALD K LEACH DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:K
Authorized Official - Last Name:LEACH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:507-357-2280
Mailing Address - Street 1:PO BOX 97
Mailing Address - Street 2:
Mailing Address - City:LECENTER
Mailing Address - State:MN
Mailing Address - Zip Code:56057
Mailing Address - Country:US
Mailing Address - Phone:507-357-2280
Mailing Address - Fax:
Practice Address - Street 1:101 SOUTH PARK AVE
Practice Address - Street 2:
Practice Address - City:LECENTER
Practice Address - State:MN
Practice Address - Zip Code:56057
Practice Address - Country:US
Practice Address - Phone:507-357-2280
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN07569122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty