Provider Demographics
NPI:1356303267
Name:LEIBINSKY-RAMOS, POLYNA (DDS)
Entity Type:Individual
Prefix:DR
First Name:POLYNA
Middle Name:
Last Name:LEIBINSKY-RAMOS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 EL PASEO RD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-6024
Mailing Address - Country:US
Mailing Address - Phone:917-667-7546
Mailing Address - Fax:575-525-9099
Practice Address - Street 1:1300 EL PASEO RD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-6024
Practice Address - Country:US
Practice Address - Phone:917-667-7546
Practice Address - Fax:575-525-9099
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045287-11223G0001X
NMDD3327122300000X
TX25760122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01584674Medicaid
NM37087274Medicaid