=====================================================
General NPI Number Information
=====================================================
NPI Number | 1326171661
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LAWRENCE LEIBOWITZ DDS PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/14/2007
-----------------------------------------------------
Last Update Date | 05/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1385 FORDHAM DR SUITE 106
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-5345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-424-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1385 FORDHAM DR SUITE 106
-----------------------------------------------------
City | VIRGINIA BEACH
-----------------------------------------------------
State | VA
-----------------------------------------------------
Zip | 23464-5345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-424-3555
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LAWRENCE LEIBOWITZ
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 757-424-3555
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 06098
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------