Provider Demographics
NPI:1154313328
Name:LEIBOWITZ, BRUCE ISRAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:ISRAEL
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 NEWARK POMPTON TPKE
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07457-1420
Mailing Address - Country:US
Mailing Address - Phone:973-835-1195
Mailing Address - Fax:973-835-0234
Practice Address - Street 1:66 NEWARK POMPTON TPKE
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:NJ
Practice Address - Zip Code:07457-1420
Practice Address - Country:US
Practice Address - Phone:973-835-1195
Practice Address - Fax:973-835-0234
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:2006-03-22
Deactivation Code:
Reactivation Date:2006-04-04
Provider Licenses
StateLicense IDTaxonomies
NJ96851223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice