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General NPI Number Information
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NPI Number | 1548473705
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Entity Type | Individual
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Provider Name | DR. MARTIN I LEON
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Gender | Male
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Dates
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Enumeration Date | 05/07/2007
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Last Update Date | 02/26/2013
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Provider Practice Location Address
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Address Line | 17525 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1519
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Country | US
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Telephone | 954-442-1884
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Fax | 954-432-3368
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Provider Business Mailing Address
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Address Line | 17525 PINES BLVD
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City | PEMBROKE PINES
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State | FL
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Zip | 33029-1519
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Country | US
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Telephone | 954-442-1884
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Fax | 954-432-3368
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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 | DN0012170
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License Number State | FL
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