Provider Demographics
NPI:1083733604
Name:LEIBOWITZ, RICHARD BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:BENJAMIN
Last Name:LEIBOWITZ
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 1:11955 LITTLE CREEK LN
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32223-7117
Mailing Address - Country:US
Mailing Address - Phone:904-268-4351
Mailing Address - Fax:
Practice Address - Street 1:12708 SAN JOSE BLVD STE 3
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32223-2600
Practice Address - Country:US
Practice Address - Phone:904-268-0904
Practice Address - Fax:904-268-0306
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4632122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist