MEDICARE: DR. DAVID IRA LEEKOFF DMD

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	0401005838	VA

General Provider Information

NPI Number	:	1770704132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID IRA LEEKOFF DMD

Provider Business Mailing Address
First Line	:	1203 PRINCE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2916
Country	:	US
Telephone Number	:	703-683-0800
Fax Number	:	703-683-6880

Provider Business Practice Location Address
First Line	:	1203 PRINCE ST
Second Line	:
City	:	ALEXANDRIA
State	:	VA
Zip	:	22314-2916
Country	:	US
Telephone Number	:	703-683-0800
Fax Number	:	703-683-6880

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

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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