Provider Demographics
NPI:1427121847
Name:MEDNICK, LEEAAT (DDS)
Entity type:Individual
Prefix:
First Name:LEEAAT
Middle Name:
Last Name:MEDNICK
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:LEEAAT
Other - Middle Name:MEDNICK
Other - Last Name:DEHNERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:4781 E CAMP LOWELL DR STE 121
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-1291
Mailing Address - Country:US
Mailing Address - Phone:520-628-2818
Mailing Address - Fax:520-319-5513
Practice Address - Street 1:4781 E CAMP LOWELL DR STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-1291
Practice Address - Country:US
Practice Address - Phone:520-628-2818
Practice Address - Fax:520-319-5513
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ55241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice