Provider Demographics
NPI:1417954074
Name:LEIBOW, WILLIAM BENJAMIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:BENJAMIN
Last Name:LEIBOW
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 1:5516 N CAMELBACK CANYON DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-1239
Mailing Address - Country:US
Mailing Address - Phone:602-840-8433
Mailing Address - Fax:
Practice Address - Street 1:4910 N 44TH ST
Practice Address - Street 2:STE 10
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-2726
Practice Address - Country:US
Practice Address - Phone:602-840-3636
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20061223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics