Healthcare Provider Details

I. General information

NPI: 1073547337
Provider Name (Legal Business Name): RICHARD LEUPOLD D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 IRVING ST., NW VAMC WASHINGTON -DENTAL 160
WASHINGTON DC
20422-0001
US

IV. Provider business mailing address

50 IRVING ST., NW VAMC WASHINGTON-DENTAL 160
WASHINGTON DC
20422-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-8000
  • Fax: 202-745-8402
Mailing address:
  • Phone: 202-745-8000
  • Fax: 202-745-8402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8614
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: