MEDICARE: LEONARD JORDAN ROUTENBERG 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	122300000X	Dentist	7237	GA

General Provider Information

NPI Number	:	1174862221
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD JORDAN ROUTENBERG DDS

Provider Business Mailing Address
First Line	:	4511 CHAMBLEE DUNWOODY RD
Second Line	:	A-2
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6243
Country	:	US
Telephone Number	:	770-394-6778
Fax Number	:	770-394-5060

Provider Business Practice Location Address
First Line	:	4511 CHAMBLEE DUNWOODY RD
Second Line	:	A-2
City	:	DUNWOODY
State	:	GA
Zip	:	30338-6243
Country	:	US
Telephone Number	:	770-394-6778
Fax Number	:	770-394-5060

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

Provider Enumeration Date	:	02/10/2013
Last Update Date	:	02/10/2013

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