Provider Demographics
NPI:1144399460
Name:LEFFALL, MARTIA LEWIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARTIA
Middle Name:LEWIS
Last Name:LEFFALL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARTIA
Other - Middle Name:ELIZABETH
Other - Last Name:LEFFALL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1420 W MOCKINGBIRD LN
Mailing Address - Street 2:SUITE 500
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75247-4931
Mailing Address - Country:US
Mailing Address - Phone:214-630-7080
Mailing Address - Fax:214-630-7085
Practice Address - Street 1:1420 W MOCKINGBIRD LN
Practice Address - Street 2:SUITE 500
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75247-4931
Practice Address - Country:US
Practice Address - Phone:214-630-7080
Practice Address - Fax:214-630-7085
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX146531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX684701OtherPMI DELTA CARE
TX110951402Medicaid
TX14653OtherCHIP NUMBER