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General NPI Number Information
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NPI Number | 1235459496
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Entity Type | Individual
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Provider Name | JAY LEFTWICH D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/10/2010
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Last Update Date | 04/14/2016
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Provider Practice Location Address
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Address Line | 1660 S COLUMBIAN WAY
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City | SEATTLE
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State | WA
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Zip | 98108-1532
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Country | US
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Telephone | 206-762-1010
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Fax |
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Provider Business Mailing Address
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Address Line | 6500 E MOCKINGBIRD LN STE 115
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City | DALLAS
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State | TX
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Zip | 75214-2483
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Country | US
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Telephone | 214-324-0233
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Fax | 214-253-2538
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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 | 25397
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License Number State | TX
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