Provider Demographics
NPI:1326050824
Name:ELIEZER, LEO (DMD)
Entity Type:Individual
Prefix:DR
First Name:LEO
Middle Name:
Last Name:ELIEZER
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 1:11925 JONES BRIDGE RD
Mailing Address - Street 2:SUITE # 200
Mailing Address - City:ALPHARETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30005-5076
Mailing Address - Country:US
Mailing Address - Phone:770-772-0606
Mailing Address - Fax:770-772-0702
Practice Address - Street 1:11925 JONES BRIDGE RD
Practice Address - Street 2:SUITE # 200
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-5076
Practice Address - Country:US
Practice Address - Phone:770-772-0606
Practice Address - Fax:770-772-0702
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2016-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0113611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice