Provider Demographics
NPI:1003825936
Name:LEADERMAN, RICHARD NEIL (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:NEIL
Last Name:LEADERMAN
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 1:1284 ELM ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:WEST SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01089-1847
Mailing Address - Country:US
Mailing Address - Phone:413-736-6185
Mailing Address - Fax:413-731-7116
Practice Address - Street 1:1284 ELM ST
Practice Address - Street 2:SUITE 2
Practice Address - City:W SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-1847
Practice Address - Country:US
Practice Address - Phone:413-736-6185
Practice Address - Fax:413-731-7116
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA124211223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics