Provider Demographics
NPI:1346847605
Name:LIFE, LEAH (DDS)
Entity type:Individual
Prefix:
First Name:LEAH
Middle Name:
Last Name:LIFE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1966 FILBERT ST UNIT B
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94123-3553
Mailing Address - Country:US
Mailing Address - Phone:860-817-1444
Mailing Address - Fax:
Practice Address - Street 1:3580 CALIFORNIA ST STE 204
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1717
Practice Address - Country:US
Practice Address - Phone:415-563-2022
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-08
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1049511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice