MEDICARE: DR. MARTIA LEWIS LEFFALL 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	14653	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	684701	OTHER	TX	PMI DELTA CARE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	14653	OTHER	TX	CHIP NUMBER

General Provider Information

NPI Number	:	1144399460
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARTIA LEWIS LEFFALL DDS

Provider Business Mailing Address
First Line	:	1420 W MOCKINGBIRD LN
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75247-4931
Country	:	US
Telephone Number	:	214-630-7080
Fax Number	:	214-630-7085

Provider Business Practice Location Address
First Line	:	1420 W MOCKINGBIRD LN
Second Line	:	SUITE 500
City	:	DALLAS
State	:	TX
Zip	:	75247-4931
Country	:	US
Telephone Number	:	214-630-7080
Fax Number	:	214-630-7085

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

Provider Enumeration Date	:	11/08/2006
Last Update Date	:	07/09/2007

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