Provider Demographics
NPI:1407858822
Name:FLUG, LEONARD I (DDS)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:I
Last Name:FLUG
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 1:819 ORIENTAL BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11235-3026
Mailing Address - Country:US
Mailing Address - Phone:718-646-3524
Mailing Address - Fax:718-646-5178
Practice Address - Street 1:819 ORIENTAL BLVD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11235-3026
Practice Address - Country:US
Practice Address - Phone:718-646-3524
Practice Address - Fax:718-646-5178
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0274941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00286466Medicaid