Provider Demographics
NPI:1962623637
Name:FUKS, LEONID (DDS)
Entity type:Individual
Prefix:
First Name:LEONID
Middle Name:
Last Name:FUKS
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 1:4424 FORT HAMILTON PKWY
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11219-1949
Mailing Address - Country:US
Mailing Address - Phone:718-437-5300
Mailing Address - Fax:718-437-6444
Practice Address - Street 1:4424 FORT HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11219-1949
Practice Address - Country:US
Practice Address - Phone:718-437-5300
Practice Address - Fax:718-437-6444
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044999122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01485134Medicaid
NY113361192OtherTIN