Healthcare Provider Details

I. General information

NPI: 1053580977
Provider Name (Legal Business Name): LEON NEHMAD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 02/25/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1750 ZION ROAD
NORTHFIELD NJ
08402
US

IV. Provider business mailing address

1750 ZION ROAD
NORTHFIELD NJ
08402
US

V. Phone/Fax

Practice location:
  • Phone: 609-641-7888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7593
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: