MEDICARE: LEFFALL FAMILY DENTISTRY, P.C.

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	261QD0000X	Dental Clinic/Center	92653802	TX

General Provider Information

NPI Number	:	1871036400
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEFFALL FAMILY DENTISTRY, P.C.

Provider Business Mailing Address
First Line	:	2814 S BECKLEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-3526
Country	:	US
Telephone Number	:	214-941-5656
Fax Number	:

Provider Business Practice Location Address
First Line	:	2814 S BECKLEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-3526
Country	:	US
Telephone Number	:	214-941-5656
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. MARTIA LEWIS LEFFALL
Credential	:	D.D.S.
Telephone Number	:	214-941-5656

Provider Enumeration Date	:	11/30/2016
Last Update Date	:	11/30/2016

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