MEDICARE: LESLIE ANDUJAR 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DN28333	FL

General Provider Information

NPI Number	:	1508554262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LESLIE ANDUJAR DDS

Provider Business Mailing Address
First Line	:	622 W 168TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10032-3720
Country	:	US
Telephone Number	:	212-305-6100
Fax Number	:

Provider Business Practice Location Address
First Line	:	3779 LAKE EMMA RD
Second Line	:
City	:	LAKE MARY
State	:	FL
Zip	:	32746-6156
Country	:	US
Telephone Number	:	407-547-1359
Fax Number	:

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

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	09/14/2023

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