Provider Demographics
NPI:1285705319
Name:LEITNER, JEFFREY MARVIN (DMD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARVIN
Last Name:LEITNER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 MARIE PKWY
Mailing Address - Street 2:
Mailing Address - City:LOUDONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12211-1564
Mailing Address - Country:US
Mailing Address - Phone:518-459-5912
Mailing Address - Fax:
Practice Address - Street 1:1425 STATE ST
Practice Address - Street 2:
Practice Address - City:SCHENECTADY
Practice Address - State:NY
Practice Address - Zip Code:12304-2821
Practice Address - Country:US
Practice Address - Phone:518-393-6098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0319671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice