Provider Demographics
NPI:1306060538
Name:LEIFERT, MELVYN MARTIN (DDS)
Entity type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:MARTIN
Last Name:LEIFERT
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:30 5TH AVE
Mailing Address - Street 2:SUITE 1J.K.
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-8859
Mailing Address - Country:US
Mailing Address - Phone:212-533-7880
Mailing Address - Fax:212-533-0162
Practice Address - Street 1:30 5TH AVE
Practice Address - Street 2:SUITE 1J.K.
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8859
Practice Address - Country:US
Practice Address - Phone:212-533-7880
Practice Address - Fax:212-533-0162
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0270221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics