MEDICARE: ROBERT LEIPZIGER D.D.S.

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	12968	MO

General Provider Information

NPI Number	:	1205825551
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT LEIPZIGER D.D.S.

Provider Business Mailing Address
First Line	:	1338 BIG BEND SQUARE SHOP CTR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-7618
Country	:	US
Telephone Number	:	636-225-3900
Fax Number	:	636-225-3945

Provider Business Practice Location Address
First Line	:	1338 BIG BEND SQUARE SHOP CTR
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63021-7618
Country	:	US
Telephone Number	:	636-225-3900
Fax Number	:	636-225-3945

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	07/08/2007

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