MEDICARE: LAWRENCE LEIBOWITZ 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	06098	VA

General Provider Information

NPI Number	:	1326171661
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE LEIBOWITZ DDS PC

Provider Business Mailing Address
First Line	:	1385 FORDHAM DR
Second Line	:	SUITE 106
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5345
Country	:	US
Telephone Number	:	757-424-3555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1385 FORDHAM DR
Second Line	:	SUITE 106
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23464-5345
Country	:	US
Telephone Number	:	757-424-3555
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE LEIBOWITZ
Credential	:	DDS
Telephone Number	:	757-424-3555

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	05/21/2008

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