MEDICARE: DR. LINDA E. LEON D.M.D.

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	1223P0300X	Periodontics	036702	NY

General Provider Information

NPI Number	:	1538276464
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LINDA E. LEON D.M.D.

Provider Business Mailing Address
First Line	:	138 STAGE RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-3513
Country	:	US
Telephone Number	:	845-783-4490
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 STAGE RD
Second Line	:
City	:	MONROE
State	:	NY
Zip	:	10950-3513
Country	:	US
Telephone Number	:	845-783-4490
Fax Number	:

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

Provider Enumeration Date	:	08/24/2006
Last Update Date	:	07/08/2007

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