Provider Demographics
NPI:1154429397
Name:LEYDSMAN, STEVEN RAYMOND
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:RAYMOND
Last Name:LEYDSMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:272 E CENTER ST
Mailing Address - Street 2:SUITE #205
Mailing Address - City:IVINS
Mailing Address - State:UT
Mailing Address - Zip Code:84738-6456
Mailing Address - Country:US
Mailing Address - Phone:435-652-8111
Mailing Address - Fax:
Practice Address - Street 1:272 E CENTER ST
Practice Address - Street 2:SUITE #205
Practice Address - City:IVINS
Practice Address - State:UT
Practice Address - Zip Code:84738-6456
Practice Address - Country:US
Practice Address - Phone:435-652-8111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT98-362684-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice