Provider Demographics
NPI:1699753558
Name:MESAMED, LEONID (DDS)
Entity type:Individual
Prefix:MR
First Name:LEONID
Middle Name:
Last Name:MESAMED
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 COVE LN
Mailing Address - Street 2:APT 3C
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-5846
Mailing Address - Country:US
Mailing Address - Phone:917-815-8112
Mailing Address - Fax:
Practice Address - Street 1:500 OCEAN AVE
Practice Address - Street 2:SUITE 1J
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-2885
Practice Address - Country:US
Practice Address - Phone:718-826-6171
Practice Address - Fax:718-508-0923
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0496641223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02226520Medicaid