MEDICARE: DR. LEON A WERTHEIMER DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DS 019271-L	PA

General Provider Information

NPI Number	:	1023083672
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEON A WERTHEIMER DDS

Provider Business Mailing Address
First Line	:	118 SUMMIT LN
Second Line	:
City	:	BALA CYNWYD
State	:	PA
Zip	:	19004-2919
Country	:	US
Telephone Number	:	610-667-2039
Fax Number	:	610-667-8089

Provider Business Practice Location Address
First Line	:	352 MONTGOMERY AVE
Second Line	:
City	:	MERION
State	:	PA
Zip	:	19066-1202
Country	:	US
Telephone Number	:	610-668-0606
Fax Number	:	610-668-8427

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	11/02/2010

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