Provider Demographics
NPI:1033396098
Name:SHEFFER, LEROY KENNETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:KENNETH
Last Name:SHEFFER
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 1:44 LINDSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-3316
Mailing Address - Country:US
Mailing Address - Phone:845-338-4733
Mailing Address - Fax:845-214-0124
Practice Address - Street 1:2600 SOUTH RD
Practice Address - Street 2:SUITE 21
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12601-7003
Practice Address - Country:US
Practice Address - Phone:845-437-4380
Practice Address - Fax:845-214-0124
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-22
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0404381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice