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NPI Code Detail

MEDICARE: DR. SHARI TARA LEAVITT DMD

MEDICARE: DR. SHARI TARA LEAVITT DMD
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
11223G0001XGeneral Practice DentistryDS25799LPA

General Provider Information

NPI Number : 1508076332
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SHARI TARA LEAVITT DMD
Provider Business Mailing Address
First Line : 3901 MARKET ST
Second Line : BOX 1936
City : PHILADELPHIA
State : PA
Zip : 19104-3133
Country : US
Telephone Number : 215-662-1030
Fax Number : 215-662-1015
Provider Business Practice Location Address
First Line : 3901 MARKET ST
Second Line : BOX 1936
City : PHILADELPHIA
State : PA
Zip : 19104-3133
Country : US
Telephone Number : 215-662-1030
Fax Number : 215-662-1015
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2007
Last Update Date : 07/08/2007

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