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General NPI Number Information
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NPI Number | 1386736767
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Entity Type | Individual
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Provider Name | JACOB LEIBOVICI DDS
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Gender | Male
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 175 TEQUESTA DR
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City | TEQUESTA
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State | FL
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Zip | 33469
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Country | US
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Telephone | 561-427-0420
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Fax | 561-427-0422
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Provider Business Mailing Address
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Address Line | 9146 DELEMAR COURT
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City | WELLINGTON
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State | FL
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Zip | 33414
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Country | US
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Telephone | 561-333-3757
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Fax | 561-427-0422
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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 | DN14459
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License Number State | FL
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