MEDICARE: NICHOLAS F. LEBER, DDS, PC

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	14777	TX

General Provider Information

NPI Number	:	1285698191
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NICHOLAS F. LEBER, DDS, PC

Provider Business Mailing Address
First Line	:	4030 N MACARTHUR BLVD
Second Line	:	SUIT 100
City	:	IRVING
State	:	TX
Zip	:	75038-6413
Country	:	US
Telephone Number	:	972-717-0077
Fax Number	:	972-717-5363

Provider Business Practice Location Address
First Line	:	4030 N MACARTHUR BLVD
Second Line	:	SUIT 100
City	:	IRVING
State	:	TX
Zip	:	75038-6413
Country	:	US
Telephone Number	:	972-717-0077
Fax Number	:	972-717-5363

Authorized Official
Title or Position	:	BUSINESS MANAGER
Name	:	MS. LYN L BLANC-CARPENTER
Credential	:
Telephone Number	:	972-717-0077

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	08/22/2020

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