Healthcare Provider Details

I. General information

NPI: 1407813280
Provider Name (Legal Business Name): ROBERT L LEFF D.M.D., P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1795 MAIN ST
SPRINGFIELD MA
01103-1077
US

IV. Provider business mailing address

1795 MAIN ST
SPRINGFIELD MA
01103-1077
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-4443
  • Fax: 413-781-4338
Mailing address:
  • Phone: 413-734-4443
  • Fax: 413-781-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number10652
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: