Provider Demographics
NPI:1124785100
Name:LEYVA, MEGAN ELIZABETH (DMD)
Entity type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:ELIZABETH
Last Name:LEYVA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13650 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-6626
Mailing Address - Country:US
Mailing Address - Phone:305-720-4998
Mailing Address - Fax:
Practice Address - Street 1:13650 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-6626
Practice Address - Country:US
Practice Address - Phone:305-720-4998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN26482122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist