Provider Demographics
NPI:1376683250
Name:LEITNER, ROBERT DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:DAVID
Last Name:LEITNER
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 1:3200 SUNSET AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:OCEAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07712-4567
Mailing Address - Country:US
Mailing Address - Phone:732-988-7645
Mailing Address - Fax:732-774-0888
Practice Address - Street 1:3200 SUNSET AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:OCEAN
Practice Address - State:NJ
Practice Address - Zip Code:07712-4567
Practice Address - Country:US
Practice Address - Phone:732-988-7645
Practice Address - Fax:732-774-0888
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ167461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice