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General NPI Number Information
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NPI Number | 1457509572
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Entity Type | Organization
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Legal Business Name | RICHARD N. LEADERMAN, DDS, PC
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Dates
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Enumeration Date | 09/03/2008
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 1284 ELM ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-1847
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Country | US
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Telephone | 413-736-6185
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Fax | 413-731-7116
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Provider Business Mailing Address
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Address Line | 1284 ELM ST
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City | WEST SPRINGFIELD
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State | MA
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Zip | 01089-1827
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Country | US
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Telephone | 413-736-6185
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Fax | 413-731-7116
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. RICHARD NEIL LEADERMAN
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Credential | D.D.S
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Telephone | 413-736-6185
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 12421
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License Number State | MA
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