Leavitt, Casey Jon
Leavitt, Casey Jon is an sole proprietor health care provider with primary practice located at 333 W. Cedar , Pocatello ID 83201-5045. He recently has only one registered license in Dental Providers / General Practice, which is considered as his primary health care specialty. Leavitt, Casey Jon can be contacted via phone (208) 233-6900.Contact Information
Primary practice address
333 W. Cedar
Pocatello ID 83201-5045
Phone: (208) 233-6900
Fax: (208) 233-6909
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / General Practice | 1223G0001X | D3630 | Idaho |
Profile Details
| NPI number | 1952495491 |
|---|---|
| LBN Legal business name | Leavitt, Casey Jon |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 2nd, 2006 |
| Last updated | Jul 8th, 2007 - about 19 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1952495491 | NPPES |
| Idaho | Other | 00016K505 | BLUE CROSS BLUE SHIELD |
| Idaho | Other | 1531413 | BLUE CROSS BLUE SHIELD |
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