MEDICARE: DR. AUSTIN LEONG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0700X	Prosthodontics	057243	NY
2	1223P0700X	Prosthodontics	22DI02617400	NJ
3	1223P0700X	Prosthodontics	DS040932	PA

General Provider Information

NPI Number	:	1215348412
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AUSTIN LEONG D.D.S.

Provider Business Mailing Address
First Line	:	1793 SPRINGDALE RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2148
Country	:	US
Telephone Number	:	856-424-7177
Fax Number	:

Provider Business Practice Location Address
First Line	:	1793 SPRINGDALE RD
Second Line	:
City	:	CHERRY HILL
State	:	NJ
Zip	:	08003-2148
Country	:	US
Telephone Number	:	856-424-7177
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2014
Last Update Date	:	08/23/2016

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