Provider Demographics
NPI:1033204953
Name:VERTSMAN, LEONARD (DMD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:VERTSMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 VILLAGE SQ EAST
Mailing Address - Street 2:C
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07011
Mailing Address - Country:US
Mailing Address - Phone:973-546-7111
Mailing Address - Fax:973-546-5225
Practice Address - Street 1:6 VILLAGE SQ EAST
Practice Address - Street 2:MODERN DENTAL
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07416
Practice Address - Country:US
Practice Address - Phone:973-546-7111
Practice Address - Fax:973-546-7111
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ199391223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice