Provider Demographics
NPI:1992812648
Name:LETA, PHILIP JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:JOSEPH
Last Name:LETA
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 1:431 COLLEGE AVENUE
Mailing Address - Street 2:
Mailing Address - City:NIAGARA FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:14305
Mailing Address - Country:US
Mailing Address - Phone:716-284-2085
Mailing Address - Fax:716-284-4313
Practice Address - Street 1:7208 BUFFALO AVENUE
Practice Address - Street 2:
Practice Address - City:NIAGARA FALLS
Practice Address - State:NY
Practice Address - Zip Code:14304
Practice Address - Country:US
Practice Address - Phone:716-283-3314
Practice Address - Fax:716-283-8367
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY32215122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00609572Medicaid