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General NPI Number Information
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NPI Number | 1083733604
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Entity Type | Individual
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Provider Name | RICHARD BENJAMIN LEIBOWITZ DDS
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Gender | Male
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 12708 SAN JOSE BLVD STE 3
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City | JACKSONVILLE
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State | FL
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Zip | 32223-2600
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Country | US
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Telephone | 904-268-0904
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Fax | 904-268-0306
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Provider Business Mailing Address
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Address Line | 11955 LITTLE CREEK LN
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City | JACKSONVILLE
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State | FL
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Zip | 32223-7117
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Country | US
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Telephone | 904-268-4351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4632
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License Number State | FL
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